Surgery for the Uninsured

Kōkua me ka Laulima: Help With Many Hands

A joint project of the Aloha Medical Mission, The Queen's Medical Center, Castle Medical Center, private surgeons and anesthesiologists, and community health centers to provide free outpatient surgery to the uninsured poor in the state of Hawai‘i.

On Friday, September 10, 2010, the first patient recruited under the Kōkua me ka Laulima: Help With Many Hands project was operated upon at The Queen's Medical Center Same Day Surgery Center. A branchial cleft cyst was removed from a 19-year-old Chinese immigrant whose family lacked health insurance and could not afford to pay for her surgical procedure.

Planning of this program began in early 2010, when Art Ushijima, president and CEO of The Queen's Medical Center, agreed to cover the costs of surgery for poor, uninsured patients with general surgical problems able to be treated as outpatients. Various private surgeons and anesthesiologists agreed to waive their surgical fees. The program became operational August 1, 2010. Castle Medical Center, under the authority given by CEO Kevin Roberts, joined in September 2010.

It is anticipated that approximately 10 to 12 patients a year will be referred from two of the five community health centers on the island of O‘ahu (the Kalihi-Pālama and Kōkua Kalihi Valley health centers).

As of April 2011, two patients have been operated on under the auspices of this program.

At present, these outpatient surgical procedures will be addressed: simple inguinal, epigastric, and umbilical hernias, anal fistulas, hemorrhoids, breast masses, neck-axillary-groin masses, and large soft tissue masses. We are estimating that there are about 40 patients per year on O‘ahu who will benefit from this program.

As the project matures, we hope to garner the participation of additional O‘ahu hospitals and community health centers. We hope to expand the range of services to include the specialties of gynecology, gastroenterology, plastics, orthopedics, and ophthalmology.

Why is there a need for this mission?

People covered by the standard “private” health insurance plans encounter few, if any, obstacles in receiving treatment for surgical illnesses. Those covered by government-sponsored insurance plans such as Med-QUEST, Medicare, and Medicaid suffer from a contracted pool of willing and/or available health-care service providers, but can eventually find treatment for their surgical problems at community health centers, hospitals, and a dwindling group of private surgeons and specialty providers.

Those who are uninsured fall into a particularly isolated group. Community health centers manage simple outpatient surgical needs, but patients with more complex surgical problems that require a hospital-based or freestanding outpatient procedure are denied care. As a consequence, the uninsured patient is unable to have their elective surgical problem properly managed.

It can easily be argued that treating these elective conditions before they develop into surgical emergencies will ultimate save many dollars for the health-care system, while avoiding the increased morbidity and risk of a mortality in these patients.