Each week, Editorial and Opinion Editor Jeanne Mariani-Belding hosts The Hot Seat, our opinion-page blog that brings in elected leaders and people in the news and lets you ask the questions during a live online chat.

On The Hot Seat last week was Dr. Collin Dang, the new CEO of the Hawaii Medical Center, which is trying to recover from losses that led to its Chapter 11 bankruptcy filing on Aug. 29.

Here is an excerpt from that Hot Seat session. To see the full conversation, go to The Hot Seat blog at www.honoluluadvertiser.com/opinion and click on "The Hot Seat." (Names of questioners are screen names given during our online chat.)

Kyle: What can be done to get more doctors on the Neighbor Islands? I have family there, and I think it's getting worse.

Dr. Dang: Most doctors are motivated primarily by their desire to serve their patients. However, they also have families and bills to pay, and must make decisions in the best interest of themselves and their families. We must find ways to ensure that specialists on the Neighbor Islands can make a sufficient living.

As you know, Hawaii Medical Center does not have any facilities on the Neighbor Islands, but we have teams of specialists who travel to the Neighbor Islands to provide services and then refer them to HMC for treatment.

Long-term solutions to the shortage of Neighbor Island doctors are going to require a cooperative effort by all stakeholders. HMC looks forward to playing a constructive role in the process.

Jo: Do you think having one major health insurance company here on the Islands hurts or helps doctors?

Dr. Dang: Hawai'i is served by several insurance companies. HMC works with all of them to provide services to our patients. Generally, having more insurance companies is better, because competition drives down premiums and (produces) more equitable reimbursement schedules for doctors.

Barbara: Will there be additional staffing cuts, and are the medical centers at risk of closure?

Dr. Dang: HMC has made some very difficult decisions to make people go. We have done this in order to save the institution so we can continue to serve the community. Cutting staff is always the last resort; however, we cannot predict what will be required in the future. We will do all we can to make HMC healthy so further layoffs will not be required.

CGM: What is the biggest challenge in dealing with the bankruptcy? How can the medical centers rebound?

Dr. Dang: HMC's highest priority is to continue to serve our patients at the very highest level. Our challenge is to do that while achieving profitability. We believe we've taken all the necessary steps at this stage to emerge from Chapter 11 by June 2009.

Lisa: What do you feel is the (one) most important thing that can be done to keep specialists in Hawai'i?

Dr. Dang: The most important thing is to create an environment where specialists can practice at the highest levels of care. We also must address issues of reimbursement by public and private insurance, and medical malpractice premiums.

Steve: What are the options for HMC if you can't return it to a profitable position? If HMC East and West are forced to close, how many patients will be affected?

Dr. Dang: HMC is completely achieving financial stability. While we do not expect to face such a situation, if HMC were unable to continue, thousands of patients would be affected. This would include in-patients and outpatients. HMC currently treats a high proportion of Medicare and Medicaid patients.

As for options, there are too many to address them here. They could range from further downsizing of the hospitals to greater specialization.

Jason: Do you see people in Hawai'i becoming less health-conscious or increasingly unhealthy? What do you see as Hawai'i's most dangerous health concern in terms of the trends and patients you see?

Dr. Dang: Hawai'i continues to have one of the healthiest populations in the U.S. However, we aren't immune to lifestyle-related health issues. Type 2 diabetes, hypertension, obesity, and other stress-related conditions continue to be on the rise in Hawai'i.

In my own field of practice, heart problems continue to be a serious challenge but we are making progress, due at least partially to public education campaigns that have encouraged people to choose a healthier lifestyle.

Peter: How are you going to cover the cost for emergency care for those who are in a life-threatening situation but don't have healthcare insurance to cover the cost? How are these costs absorbed into the hospital?

Dr. Dang: HMC's policy is to never turn away emergency care for life-threatening situations. The costs of treating uninsured patients are a challenge for all hospitals, especially for HMC, as we have the only hospital emergency room in West O'ahu. Costs of treating uninsured patients are something we anticipate and absorb on a routine basis.

Tina: Would it be possible to lower the cost of medical procedures if people pay in cash or by credit card? Because there are a lot of people who can't afford health insurance. Without health insurance, the costs seem astronomical. Maybe by lowering the cost of procedures, the hospital can make more money by taking in cash payments, and people seeking medical attention will get the help they need. What do you think?

Dr. Dang: The profit margins that hospitals make on providing care are very slim to start with. Both public and private insurance reimbursements have become increasingly insufficient to meet the actual cost of care. The same is true when a patient pays by cash or credit card. The costs of treatment are not entirely covered, so it is not feasible to lower those charges even further.

Bill: Do you foresee a time when all the medical centers in Hawai'i will combine together under one umbrella organization in order to survive? It sure seems like we're heading in that direction.

Dr. Dang: It is difficult to imagine all of Hawai'i's medical centers under one organization. Each of our hospitals provides unique and distinct services and have different organizational cultures. This diversity is of great value to patients, because it provides them choice.

It's possible that some institutions will find it advantageous to combine their operations in a search for greater efficiency and better care.

Reach Jeanne Mariani-Belding at jmbelding@honoluluadvertiser.com.