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.
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
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
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.