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View Count: 109 |  Publish Date: April 05, 2014
In Hawaii, a healthcare system apart

HONOLULU — When the giant kapok and nawa trees that tower over the Queens Medical Center in downtown Honolulu were planted more than a century ago, Hawaii faced a health crisis.
Many on the islands, including the queen who founded the hospital in 1859, feared that native Hawaiians, devastated by smallpox, measles and other illnesses brought by foreigners, were in danger of dying off completely.
Today, the people who walk under these trees are some of the healthiest in America.
Hawaiians live longer than their counterparts on the mainland. They die less frequently from common diseases, such as breast and colon cancers, even though these cancers occur more often here than in most other states. They also pay less for their care; the states healthcare costs are among the lowest in the country.
Hawaiis success owes much to the states trailblazing health system and its long history of near-universal health insurance.
Forty years ago, the state became the first to require employers to provide health benefits, codifying a tradition that grew out of Hawaiis agrarian past, when sugar and pineapple plantations employed doctors to care for their workers.
That system has led to some of the highest rates of coverage and best access to medical care in the country.
There has always been a mentality here that if you are sick, you go to the doctor. Its just part of the culture, said Myra Williams, 64, who has lived in Hawaii for 35 years and was recently treated successfully for early-stage breast cancer.
Nearly 99% of the patients at the cancer center at Queens have health coverage, a level unheard of at most urban medical centers on the mainland.
Healthcare in America is a tale of two countries.
Residents of the healthiest communities live as much as 14 years longer on average than those in unhealthy places. They are a third less likely to die from treatable illnesses such as breast cancer, childhood measles and diabetes, according to data from the Commonwealth Fund, a foundation dedicated to improving the healthcare system.
Big variations in poverty, education and diet may explain part of this divide. In Hawaii, the large share of residents of East Asian descent, who have lower mortality rates for many diseases, may also have an impact.
But differences in local health systems nationwide — including disparities in insurance coverage — also likely play an important role, according to an analysis of local and national healthcare data, a review of academic studies, interviews with scores of experts, and visits to communities across the country.
Nearly everyone is covered in the nations healthiest places, including Hawaii, Massachusetts and parts of the Upper Midwest. By contrast, fewer than 7 in 10 working-age adults have health insurance in parts of Texas, Florida and the Deep South — areas with some of the highest rates of death from preventable illnesses.
In Texas, which has the lowest rate of insurance coverage in the nation, residents are 40% more likely to die from breast cancer than they are in Hawaii, according to federal cancer data.
These disparities may grow even larger in coming years as the Affordable Care Act is implemented unevenly around the country. Although the law offers states the opportunity to guarantee their residents insurance, only about half the states have elected to do so.
In Hawaii, health insurance has reshaped healthcare, from the smallest clinics to major urban hospitals, affecting when patients are treated and even how they recover.
On Oahus North Shore, a rural stretch of Hawaiis most populous island once covered with sugar cane plantations, Dr. Randall Suzuka sees many of the routine complaints common to a community physicians office.
One morning at Haleiwa Family Health Center, Suzuka, who has worked there since 1986, tended to an elderly woman having trouble sleeping, a municipal worker with a strained neck and a 10-month-old who had cut her finger on broken glass.
But his office, originally opened by a former plantation doctor, differs from many medical practices in one key way: He rarely needs to discuss skipping care with a patient just because the person doesnt have adequate insurance.
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 age   cancer   care   Hawaii   health   insurance   Los Angeles Times 

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 age   cancer   care   Hawaii   health   insurance   Los Angeles Times 
Time: 8:19  |  News Code: 395033  |  Site: L. A. Times
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