Recent discussions about One Health Hawaii, the affiliation between HMSA and Hawaii Pacific Health, has sparked important public questions.

In evaluating any health care changes, one principle should guide policymakers: primary care must be protected and strengthened.

Primary care is where prevention happens. It is where chronic diseases are managed before complications arise. It is where mental health challenges are identified early. It is where families build long-term, trusted relationships with physicians.

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For our children, a strong primary care is paramount.  Pediatric primary care is the foundation of lifelong health. Well-child visits are where developmental delays are detected, autism is screened, learning concerns are identified, vaccines are administered and parental guidance is provided.

During well and illness visits, pediatricians monitor growth, nutrition, mental health and social stressors that can shape outcomes for decades.

When pediatric primary care is strong we are building tomorrow’s healthier workforce and saving health care dollars.

Yet pediatric primary care faces unique financial pressures. Children are generally healthy, but often a cause of parental worry which means pediatric practices must be accessible.

It is costly to ensure that vaccines are stored in the office and readily available for patients. Pediatric services are time intensive and undervalued in traditional health insurance models.

Hospitals rely heavily on inpatient and procedural revenue. Pediatric primary care, by contrast, works to prevent hospitalizations. That is a public health success — but financially, it can place primary care at a disadvantage unless policy deliberately protects it.

This is why we all should be dismayed that the Senate’s committees on Health and Human Services and Commerce and Consumer Protection refused to advance Senate Bill 2690. This bill “was to boost investment in primary care in Hawaiʻi.”

If Hawaiʻi is serious about long-term health care cost control and better outcomes, it must shift more resources to primary care. SB 2690 would have helped stabilize both adult and pediatric practices.
Such a policy would:

• support independent community primary care practices;
• strengthen neighbor island access;
• improve developmental and behavioral health screening;
• reduce avoidable emergency department visits; and
• promote long-term population health.

For children, early investment produces lifelong returns. Identifying speech delays at age 2 is far less costly than remedial education later. Managing childhood obesity early can reduce future diabetes. Addressing anxiety in adolescence can prevent adult disability.

Pediatric primary care is one of the highest-value investments a health system can make. We must not overlook that today’s children are tomorrow’s workforce.

Without a commitment to invest in primary care, systemic health care changes could unintentionally weaken independent primary care practices — including pediatric offices that serve as medical homes for thousands of Hawaiʻi’s keiki. Small primary care practices lack the negotiating leverage of large hospital systems.

If health care payment to primary care practice stagnates while costs rise, closures and acquisitions may follow. That would mean fewer choices for families and longer waits for care.

If a health plan-health system alignment commits to a deliberate primary care investment to support a robust, sustainable primary care workforce, Hawaiʻi could build a more coordinated, prevention-centered system that benefits both adults and children.

But, without intentional rebalancing, we risk reinforcing a health care model that undervalues prevention — particularly pediatric prevention, where benefits accrue over decades rather than fiscal quarters.

As policymakers consider the future of Hawaiʻi’s health system, please ask: does this strengthen the pediatrician’s office, the family doctor’s clinic and your internist’s practice — or does it weaken them?

Because a system that invests in primary care, especially for children, is not just managing illness. It is investing in Hawaiʻi’s future.