The numbers, which are collected by Hawai'i Health Information from the hospitals, will be included in the Health Trends report due later this month that is done for the HMSA Foundation every two years, Forbes said.

Total hospital charges include all "a la carte" fees for room and board, medications, staff and testing. Physician charges are not included. A hospitalization is defined as any time a patient is formally admitted to a hospital for 24 hours or longer.

Richard Meiers, president of the Healthcare Association of Hawai'i, said it's unfair to compare today's hospital costs with those of a decade ago.

"The cost of doing business in Hawai'i has skyrocketed in the past 10 years and healthcare inflation has been averaging in the double-digits probably most of the last eight years," Meiers said.

"When you put the drugs and the medications and the equipment together, that is what has caused healthcare costs to go up so much."

Also, a shortage of nurses and other healthcare workers has resulted in pay hikes for such employees.

RISING LABOR COSTS

Regarding pay increases granted to unionized nurses, Meiers said, "Somebody has to pay for these settlements."

Changes to Medicaid and Medicare laws, meanwhile, have drastically reduced the amount of reimbursements medical care providers can receive from those programs, Meiers said. Hawai'i medical providers get no cost of living adjustments to reflect higher costs here, he said.

Changes in workers compensation rules also have affected hospitals, Meiers said.

"We get hit both ways," he said. "The reimbursements to us as providers are not really fair and yet we get hit the other way, too, because we're such big employers. We're the second largest private industry in the state."

Additionally, the number of charity and uncompensated care cases — collectively those instances when the hospital is not paid — has increased dramatically, Meiers said.

"We still have to take care of people; we can't put them out on the street," he said.

"No hospital is making a profit and we need them to make a profit so they can reinvest in technology and facilities," Forbes said. "Those are very serious problems."

FINANCIAL PROBLEMS

Meiers said practically all the hospitals are facing financial difficulties. He pointed to the recent money troubles faced by the St. Francis Healthcare System of Hawaii.

"We have other hospitals that are barely able to hang on right now," he said. "It's a real serious issue."

Forbes also said health insurance companies are not the reason for increasing hospital costs.

"Insurance premiums do not drive the cost of healthcare," she said. "It's the actual cost of the actual medical care that drives costs."

Forbes said one reason the number of patients has not risen sharply is because modernization has led to fewer patients.

"It's a technological change where patients that used to have to be hospitalized are now operated on in ... outpatient surgery," she said.

Forbes said she finds it interesting that the average length of stay has gone down even as the number of total hospitalizations has increased only slightly.

"It has gone down nationally," she said. "Because government payers are paying less ... that has driven a reduction in the length of stay."

As for who is paying for the higher cost in hospitalizations, the number of cases charged primarily to the Department of Defense, Medicaid, Quest and Medicare have increased while those charged primarily to private insurance companies have declined.

Forbes said that is likely due to the aging population swelling the ranks of those eligible for government subsidies for medical assistance.

Reach Gordon Y.K. Pang at gpang@honoluluadvertiser.com.