Hawaii

#HospitalFails

While nonprofit hospitals are organized as charities to deliver affordable health care to those in their communities who need it most, many of America’s nonprofits are making big money. Nonprofit hospitals around the country are paying executives exorbitant salaries and adopting policies that put profits over patients, like pursuing predatory collection practices, closing hospitals that are critical to underserved areas but aren’t performing financially, and failing to provide free or reduced-cost care for qualifying low-income patients. Too often, these policies are combined with poor health outcomes for patients.

Last updated: June 25, 2025 at 6:18am

Charity Care Spending

Hawaii had a “fair share deficit” of $197 million dollars for the fiscal year ending in 2021, according to the Lown Institute Hospitals Index. In other words, Hawaii’s nonprofit hospitals pocketed a whopping $197 million more in tax breaks than they spent on community benefits and charity care for low-income patients. In fact, the Lown Institute found that 90% of Hawaii’s nonprofit hospitals ran a fair share deficit in the 2021 fiscal year.¹

Medical Debt and Consumer Protections

Hawaii’s consumer protection policies for medical debt are rated as “POOR.” For example, Hawaii:

Does not prohibit medical providers from going so far as to seize a patient’s bank account to collect an unpaid medical bill.
Does not prohibit hospitals from selling a patient’s medical debt.
Does not require hospitals to offer a reasonable payment plan for sending an unpaid medical bill to collections.
Does not require hospitals to screen patients for insurance eligibility or eligibility for other programs and discounts.²

Price Transparency

A survey of 2,000 hospitals nationwide from July to November 2024 found that none of the 8 Hawaii hospitals reviewed – not a single hospital – had complied with federal regulations requiring all hospitals to post their prices online and make them easily accessible and searchable.³

Hospital Overcharging

On average, from 2020 to 2022, hospitals in Hawaii charged patients with private insurance an average of 245% of what they charged Medicare patients for the same services.⁴

Hospital Safety

Hawaii ranks 41^st in the country for hospital safety, with barely 16.7% of its hospitals earning an ‘A’ grade for safety.⁵

Grade: #HospitalFail

Lown Institute, “Lown Institute Hospitals Index: 2024 Results Fair Share Spending,” April 2024, https://lownhospitalsindex.org/hospital-fair-share-spending-2024/
Innovation for Justice, University of Arizona and the University of Utah, “Medical Debt Policy Scorecard,” October 2021, https://www.medicaldebtpolicyscorecard.org/state/HI
PatientRightsAdvocate.org, “Seventh Semi-Annual Hospital Price Transparency Compliance Report,” November 2024, https://www.patientrightsadvocate.org/seventh-semi-annual-hospital-price-transparency-report-november-2024, pg. 28
Rand Corporation, “Prices Paid to Hospitals by Private Health Plans: Findings from Round 5.1 of an Employer-Led Transparency Initiative,” December 2024, https://www.rand.org/pubs/research_reports/RRA1144-2-v2.html
Leapfrog Hospital Safety Grade, State Rankings, Spring 2025, https://www.hospitalsafetygrade.org/your-hospitals-safety-grade/state-rankings

Consumers for Quality Care (CQC) is a coalition of advocates and former policymakers working to provide a voice for patients in the health care debate as they demand better care. CQC is led by a board of directors that includes the Honorable Donna Christensen, physician and former Member of Congress; Jim Manley, former senior advisor to Senators Edward Kennedy and Harry Reid; Jason Resendez, community advocate and health care strategist; and Mary L. Smith, former CEO of the Indian Health Service.