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Personalities: Island Life

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Elizabeth Giesting took the helm of the Hawaii Primary Care Association in 1995 as a one-woman operation, managing a budget of $298,000 that supported six community health centers. Today, she manages a team of 17 employees and a $4.2 million budget that supports 14 community health centers. Since taking over the association, she has launched a number of programs, including the Hawaii Immigrant Health Initiative and Hawaii Covering Kids, that benefit low-income or underserved populations.

On Hawaii's healthcare climate: Hawaii is unique in having an employer mandate to provide medical insurance. Employers are required to provide a standard insurance package to permanent employees who work 20 or more hours per week. As a result, Hawaii has one of the highest rates of employer-covered health insurance in the nation. While we enjoy the system's security, there are some downsides: Some employers manipulate hours and schedules to stay below the 20-hour mark, and Hawaii's wages are low compared to the cost of living because employers have a hard time covering the health benefit as well as salaries.

On the most important issue in healthcare today: I believe our problem stems from a fragmented, market-driven approach to the healthcare. The United States needs to establish a national health insurance program, preferably a nonprofit single-payer system, with a priority of coordinated patient-centered care. We can afford good, equitable care if we eliminate the profiteering, marketing, and duplication characteristic of our system.

On what drew her to the industry: I earned a master's degree in instructional system technology—which, by chance, led me to a job at a university-based medical school. There I found healthcare to be a compelling and meaningful pursuit. I was in the right place at the right time when I applied for a position to direct a community health center in Honolulu, and that led me to where I am now—an advocate for policies that support healthcare for underserved communities and for community health centers.

On her goals for the Hawaii Primary Care Association: I'm a true believer in the community health center model for all communities, not just for the traditionally underserved. My goal is to expand that model via partnerships with other parts of the healthcare system that are not yet encouraged to work cohesively to meet patient needs. Hawaii and the nation need to make some major changes to convert our heartbreaking, frustrating, costly, and inefficient financing delivery systems into something that responds to human needs and is worth paying for.

Ben Cole

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