Finding the source of Hawai'i's health care system: Discovering the plantation experience

This dissertation examines the contributions of plantation medicine to Hawai'i's current health care system and how this experience prepared Hawai'i for managed care. Plantation medicine's experiences of the nineteenth and twentieth centuries were investigated to determine the impact on Hawai'i's current and future health system. Plantation medicine's experiences are examined to determine the extent they stimulated change regarding the way health care is currently delivered. Query into the plantation era identifies conditions similar to current conditions. The findings from this study: (a) revealed plantation medicine's contributions to Hawai'i's current health care system, (b) identified methods used by plantation medicine to achieve goals in austere times, and (c) provided insight into the application of successful methods to address similar health needs in the 21st century.;The historical method of research used archival records for inquiry and analysis. The research questions that guided the inquiry and analysis were: (a) What was the status of plantation medicine during the period 1835 to 2000? (b) What did plantation medicine do in response to the economic, political, and social conditions to meet the health care needs of the people of Hawai'i? and (c) Were there differences between rural and urban needs and in the responses of plantation medicine to meet these needs? The oral history interview method utilized plantation officials who worked during the latter part of this period. Hawai'i archival records at the state, county, and local levels were examined, as were those at selected plantations. National archival records were utilized for evaluation purposes. These records were enhanced with interviews of living representatives of this era.;The findings indicate that plantation medicine is unique, financing futuristic and fostered complementary medicine. Plantation medicines uniqueness came from the principles derived from the multicultural make-up, the geographic isolation, paternalism, physician leadership and organization, patient involvement and political process. The financial system was futuristic in the means of reimbursement based on salary or capitation. Plantation medicine coexisted with alternative medicine to include the Hawai'ian kahuna, Chinese herbalist, Japanese masseuse, and other forms of indigenous medicine. The conclusion is that plantation medicine did Hawaii's health care system.;Implications of this study relate to the focus of today's health care system on cost avoidance, comprehensive services, and management of costs. For those who use the system, the comprehensive of nature of care in Hawai'i, its breadth and depth and the system's continual thrust towards universal coverage are all revealed as having roots in the past eras of the state. With that information in hand and knowing the more recent history of the economic viability of several hospitals, the legacy of plantation medicine becomes much more salient.