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The supply of health care resources impacts our ability to treat illness in a timely and effective manner and to provide preventive services in support of optimal health. Typical questions asked about health resources include the following:

Who provides health care services?

The people providing health care services, including physicians, nurses, and dentists, collectively comprise the health care workforce. The health care workforce was one of the few sectors of the economy that grew between 1990 and 2007. Currently, one out of every 11 employed Hawai'i residents works in health care.

Physicians, dentists and nurses are among the providers of conventional medical1 services, which include interventions taught widely in medical schools and generally available in U.S. hospitals.

Hawai'i ranks 8th among states in physicians in patient care per capita.2 With 3.2 active3 physicians per 1,000 resident population, Hawai'i has more physicians per capita than the national average (2.8 physicians per 1,000 population). Like their mainland counterparts who are concentrated in urban areas, Hawai'i's physicians are highly concentrated in a small area on O'ahu. In 2007, about 80 percent were practicing on O'ahu. O'ahu has approximately 3.6 physicians per 1,000 population compared to about 2.1 physicians per 1,000 population in the rural counties of Hawai'i, Kaua'i, and Maui.   While Hawai'i's rural counties have more family practice/general medicine physicians per capita than O'ahu, these rural counties have far fewer specialists available to care for residents.

Hawai'i has more dentists per capita than the nation as a whole.4 This is largely driven by the high concentration of dentists on O'ahu, with 88 per 100,000 population, which is well above the national rate of 64. However, Hawai'i's rural counties experience a shortage of dentists, with about 60 dentists per 100,000. Hawai'i, Kaua'i, and Maui Counties are each designated Dental Health Professional Shortage Areas by the federal Health Resource and Service Administration (HRSA).

While the number of registered nurses (RNs) in Hawai'i has increased in recent years (totaling almost 12,000 in 2007),5 only about 81 percent are employed in nursing.6 O'ahu has the highest concentration of RNs; Maui County the lowest. Hawai'i ranks 41st among all states, with 75 employed nurses per 10,000 residents. The U.S. rate is 82 per 10,000 residents.7

Health resources, particularly the availability of health care service providers, are inadequate in several areas of the state according to federal guidelines. Rural areas of the state are most affected by the unavailability of health care resources in the counties of Hawai'i, Maui, and Kaua'i. On O'ahu, six areas are designated inadequate: Kalihi-Palama, Kalihi Valley, Ko'olau Loa, Waikiki, Waimanalo, and Wai'anae.

Interest in alternative medicine is growing.8 Alternative medicine is defined as interventions that are neither widely taught in medical schools nor generally available in U.S. hospitals. These activities include relaxation techniques, herbal medicine, massage, chiropractic care, spiritual healing, homeopathy, hypnosis, biofeedback, and acupuncture. Hawai'i has seen the number of licensed alternative providers--primarily acupuncturists, chiropractors, and massage therapists--increase in all four counties over the past decade. This is due in part to the growing acceptability of certain alternative medical practices by health plans. Over the past decade, Maui county has consistently had the highest number of licensed alternative providers in the state.

In what kinds of facilities or settings are health services provided?

The facilities or settings in which care is provided include hospitals, long-term care facilities, community health clinics, home care agencies, care homes, physicians' offices, laboratory and radiology facilities, pharmacies, and offices of allied and alternative health providers. Available data focus on hospitals and long-term care facilities.

In 2010, the State Health Planning and Development Agency (SHPDA) recognized 23 civilian acute care hospitals and Tripler Army Medical Center, which supplies integrated services to all three military branches. Eleven of these 23 hospitals, each with 75 beds or more, are considered major community hospitals. Nine major community hospitals are located on O'ahu.

The 23 acute care civilian facilities accounted for 2,609 acute care beds in 2010. This bed supply equates to 1.9 beds per 1,000 residents, fewer than the 2.5 beds per 1,000 residents for the nation overall. Hawai'i's supply of acute care beds per capita slightly declined between 1990 and 2010. This was due to the faster growth rate of Hawai'i's population compared to acute care beds, as the number of beds has remained fairly stable over the past decade. Hawai'i ranks 33rd among all states (including the District of Columbia) in the number of available beds per capita.9

Long-term care beds consist of skilled nursing, intermediate care, and mixed-use (swing) beds. The supply of long-term beds in Hawai'i has been relatively constant for the past several years. In 2010, the number of beds totaled 4,269. Hawai'i's certified nursing facility occupancy rate is 94.8 percent, the highest of all states.10 In contrast, only 1.6 percent of Hawai'i's population aged 65 and older resides in a nursing home. In this regard, Hawai'i ranks 49th among all states.

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