| 2018 Edition: Healthcare Openness and Access Project 2018 Edition: Healthcare Openness and Access Project
| Healthcare Healthcare
| Research Papers Research Papers
June 13, 2018

16 | Hawaii

Score: 3.36 (US mean: 3.20, median: 3.17), Rank: 16

The Healthcare Openness and Access Project (HOAP) measures how open and accessible each state’s healthcare system is to patient and provider preferences. The overall HOAP index is the average of 10 categories, referred to as subindexes, each of which is in turn an average of multiple indicators.

The HOAP index ranks Hawaii near the top of the 51 jurisdictions analyzed. Some of the state’s highest scores are in the Corporate Subindex and the Taxation Subindex, and some of its lowest are in the Occupational Regulation Subindex and the Insurance Subindex. Hawaii’s score and rank in each subindex is given below, along with its score for each individual indicator.

For the overall index, the subindexes, and the indicators, 1 is the lowest score and 5 is the highest.

Corporate Subindex

Score: 5.00 (US mean: 2.59, median: 2.00), Rank: 1

A higher score indicates that healthcare professionals and others have greater flexibility with regard to ownership, business structure, and employment in the healthcare sector.

Indicator	State score	US mean
State allows the corporate practice of medicine	5	2.25
State allows businesses to employ licensed healthcare professionals	5	3.04
State allows nonlicensed individuals to own/operate medical entities	5	2.88
State allows licensed individuals to split fees with nonlicensed individuals	5	2.18

Direct Primary Care Subindex

Score: 3.00 (US mean: 3.49, median: 3.33), Rank: 37

A higher score indicates that the state’s environment is more conducive to the establishment of direct primary care (DPC) practices as an alternative method of financing primary care.

Indicator	State score	US mean
State has pro-DPC laws	3	3.94
State has higher market demand for DPC	2	2.96
State has more DPC practices per capita	4	3.57

Insurance Subindex

Score: 2.80 (US mean: 3.44, median: 3.60), Rank: 42

A higher score indicates that insurers have greater flexibility to determine the structure and pricing of health insurance policies.

Indicator	State score	US mean
State mandates fewer health insurance benefits	2	1.61
State mandates less rate review	1	2.29
State does not expand on federal age rating limitations	5	4.73
State does not expand on federal tobacco rating limitations	5	4.29
State does not expand on federal geographic rating limitations	1	4.25

Medical Liability Subindex

Score: 3.00 (US mean: 3.34, median: 3.33), Rank: 35

A higher score indicates that physicians and others are less constrained by the threat of malpractice litigation.

Indicator	State score	US mean
State physicians pay fewer malpractice actions	3	3.76
State physicians pay lower malpractice premiums	4	3.49
State has adopted more reforms to modulate malpractice litigation	2	2.76

Occupational Regulation Subindex

Score: 2.60 (US mean: 3.13, median: 3.00), Rank: 36

A higher score indicates that medical professionals have easier access to licensure and employment and greater discretion regarding the services they offer.

Indicator	State score	US mean
State allows medical licensure reciprocity with other states	1	2.80
State has fewer continuing medical education requirements	3	2.80
State allows nurse practitioners broad scope of practice	5	3.43
State has fewer optician licensing requirements	3	3.55
State allows direct-entry midwifery	1	3.08

Pharmaceutical Access Subindex

Score: 3.00 (US mean: 3.11, median: 3.00), Rank: 23

A higher score indicates that patients have easier access to certain classes of drugs, including experimental and unconventional treatments.

Indicator	State score	US mean
State allows greater access to experimental drugs	1	3.04
State allows access to medical marijuana	5	4.14
State allows easier access to pseudoephedrine	5	4.02
State allows access to oral contraceptives without physician prescription	1	1.24

Provider Regulation Subindex

Score: 3.00 (US mean: 2.41, median: 2.67), Rank: 9

A higher score indicates that healthcare providers have greater flexibility to determine hospital and pharmacy operations.

Indicator	State score	US mean
State has fewer certificate-of-need restrictions	1	2.86
State puts fewer restrictions on compounding pharmacies	5	1.98
State lacks burdensome prescription monitoring mandates	3	2.39

Public Health Subindex

Score: 3.67 (US mean: 3.86, median: 4.00), Rank: 27

A higher score indicates that residents have easier access to substance abuse remedies and greater discretion when offering medical assistance to other people.

Indicator	State score	US mean
State allows access to e-cigarettes	1	2.88
State allows access to naloxone	5	3.88
State has strong “Good Samaritan” protection	5	4.80

Taxation Subindex

Score: 4.00 (US mean: 3.67, median: 3.67), Rank: 9

A higher score indicates that the state imposes a lower burden of taxation for certain healthcare services, financing methods, and devices.

Indicator	State score	US mean
State has fewer provider taxes	3	2.14
State has fewer health savings account (HSA) taxes	5	4.69
State has fewer medical device taxes	4	4.20

Telemedicine Subindex

Score: 3.50 (US mean: 3.01, median: 3.00), Rank: 9

A higher score indicates that the state’s environment is more conducive for telemedicine practitioners.

Indicator	State score	US mean
State reimburses Medicaid providers at parity for telemedicine	3	3.47
State has less restrictive telepresenter requirements	5	4.24
State reimburses Medicaid providers at parity for remote monitoring	5	2.20
State allows online prescribing	1	2.14

For a complete explanation of the methodology used to calculate Hawaii’s HOAP index score, see Darcy N. Bryan, Jared Rhoads, and Robert Graboyes, “Healthcare Openness and Access Project: Mapping the Frontier for the Next Generation of American Healthcare, June 2018 Update” (Project Overview, Mercatus Center at George Mason University, Arlington, VA, April 2019).