What U.S. Medical Systems Can Learn From Hawaii and Alaska


A recent New York Times article entitled “In Hawaii’s health system, lessons for lawmakers” opens with a story of a Honolulu employee at a U.S.-based ice-cream chain who has health insurance through that chain.

While the chain typically doesn’t offer health insurance to its employees on the mainland, it has to do so in the “Aloha state” due to health industry regulations there.

Hawaii makes your employer guarantee you health coverage

Hawaii was the first state to mandate what is effectively universal healthcare for every person who works, and their families…and they did it all the way back in 1974.

And like a dream-version of those no-medical-exam insurance ads on TV, no one can be denied coverage. It’s state law.

While they were at it, state legislators mandated clearly-defined boundaries to force competing insurers to keep costs under control.

Premiums are the same for everyone

Another way Hawaii has kept healthcare costs down is to hold premiums the same for everyone, sharing costs and risks equally between all 1.4 million residents.

Since mandating insurance through employment began in Hawaii, the state has gained more jobs than it lost every year but one.

Hawaiians are pretty healthy (and not just because they live in Hawaii)

Hawaii ranks near the top compared to other states in life expectancy and low infant mortality.

Because of a heavy focus on preventative care, things like screenings, counselling, and vaccines are included in even the most basic plans.

And while locals have been crying fowl on Hawaii’s healthcare system for more than a decade (for everything from a lack of doctors, to rising insurance rates, to employer claims of needless overpayments) the state has still managed to keep healthcare costs low compared to other states (currently 8 per cent of GDP for Hawaii, as opposed to a 14 per cent national average.)

Alaska has a 100year plan for health

Alaska is no Hawaii when it comes to surveys of top states for healthcare (Hawaii often ranks at-or-near-the-top, while Alaska tends to sit comfortably in the middle of such rankings), but there’s a ton to be learned from medical practices and planning in this lonely, beautiful expanse.

Take Alaska’s Southcentral Foundation, a health care system owned and managed by Alaska’s Native people.

Members of that foundation, and others in the tribal healthcare system, scoff at 1, 2, and 5 year plans, talking more in the range of generations or centuries – a practice that can seem both tedious and inspiring.

A unique system of care known as “Nuka” – an Eskimo-Aleut name that can refer to large and strong structures, as well as people – envisions things like:

  • eliminating child abuse within a generation
  • re-establishing the system of tribal elders within a generation
  • changing the entire healthcare system in the next 30 years
  • planning for health over the next 100 years

It’s a way of thinking that one administrator for Centers for Medicare and Medicaid Services has called “the leading example of health care redesign in the nation, maybe the world.”

Food for thought for industry members in the rest of the country? In Hawaii and Alaska’s health systems, lessons for healthcare professionals.



Comparing some of the world’s best healthcare plans

More on Hawaii’s “pioneering” healthcare system

Criticism of Hawaii’s healthcare system

A firsthand look at Alaska’s native/tribal healthcare vision

Alaska system serving as model for Wales, UK

Southcentral Foundation in Alaska and the Nuka program

Why Alaska is perfectly positioned to excel through HIE, according to the head of IT at New England’s Beth Israel Deaconess Medical Center

Tera Rowland
Contributor Tera Rowland

Tera Rowland is the vice president of Soliant and has worked in the healthcare staffing industry for almost 20 years in public relations, social media, marketing and operations. In addition to Soliant, Tera worked at the Mayo Clinic as an internal communication manager and for the Children’s Miracle Network. She is a member of the American Marketing Association and the American Staffing Association. Also, Tera has served on the board of directors for the Jacksonville Women’s Leadership Forum as part of the communication committee. She has a Bachelor of Science degree in Public Relations as well as a Master of Business Administration in Marketing from the University of North Florida and has been published in the Huffington Post, Healthcare Finance News, Healthcare Traveler Magazine, and Scrubs Magazine. Make sure to read the rest of Tera's blogs!