Coordination between CHC and HMOs

At Issue: The dire need to coordinate medical referral cases between CHC and local Health Maintenance Organizations (clinics).

Our View: Coordination would eliminate hardship by resolving this issue forthwith to facilitate timely treatment.

The Department of Public Health and Environmental Services has worked long and hard to ensure that acute patients requiring tertiary medical attention at off-island hospitals are sent on a timely basis even against skyrocketing costs.

However, the proliferation of HMOs in the NMI where each clinic has its own group of doctors and specialists with providers other than Straub and Queens hospitals must be resolved forthwith.

A recent case involved refusal by a health provider to shoulder medical cost unless the patient is treated by their client (hospital). The refusal came after a specialist from another Honolulu clinic recommended treatment at the clinic where he works. This setback after a reported agreement to send the patient to Honolulu.

It is an issue that could continue to be problematic for medical referees who subscribe to private health insurers. Either HMOs (private health clinics) are required to begin bringing in their own specialists and refer patients on their own to their client (hospitals) or a single payer policy that grants patients the option to choose which clinic — on or off-island– to go to.

By no means is this issue easily understood by subscribers with private health insurers. And this isn’t a reason for complacency on the part of health officials and providers either. It is too complicated for lay people. As such, it is a matter that warrants immediate review and resolution. It’s an issue that will eventually take up a lot of debate, a long and arduous process, in that it may also require waiting to see how the US Congress and the administration disposes of patients’ rights versus HMOs.

In fact, all must begin sifting through the changing debates at the national level to get an inkling of how this issue has evolved over the last several years. It’s a major health issue that requires healthy minds among key players. It’s an involved matter requiring critical diagnosis to save patients who must deal with the skyrocketing cost of health care. It’s a costly issue especially for private employers with large number of employees.

We hope that all concerns converge to begin addressing this matter in hopes that a solution is reached sooner than later. Si Yuus Maase`!