Why important?
By understanding the health status of our tourists, we may collectively identify ways to improve their experience in Hawaii. Also, since Hawaii is one of the world’s major tourist destinations, we may be able to identify patterns in tourist illness from which others can learn.

According to the Department of Business, Economic Development and Tourism, “Tourism is the activity most responsible for Hawaii’s current economic growth and standard of living ¹.” Periodically, politicians talk about Hawaii as a potential health tourism destination. For the most part, though, healthcare and tourism merge when visitors get sick and require treatment in Hawaii’s hospitals and emergency departments.

Why hospitalized?
For residents of Hawaii, 1,016 out of every 10,000 individuals required hospitalization between 2000 and 2006² . The experience for visitors was very different, with only 3.66 foreign visitors and 11.04 mainland visitors out of every 10,000 requiring hospitalization³  during the same period. Fortunately visitors are usually healthy.

The patterns of hospitalization for Hawaii residents are similar to those across the country. Maternity and newborn services account for the largest volume of patients, by far. (See Other Views: 'By reason for hospitalization').  Following maternity and newborn are conditions which develop over time and acute conditions requiring immediate attention. Cardiology, pulmonology and neurological conditions are prominent among the elderly, although they start showing up in the working years. Patterns among visitors are different. Patterns of hospitalization for foreign visitors are similar to those of mainland visitors for most product lines, although foreign visitors are much less likely to be hospitalized at all. The greatest variations are by age group.

For mainland visitors, a majority of patients are hospitalized for one of six product lines: cardiology (13%), general surgery (11%), gastroenterology (9%), orthopedic surgery (8%), pulmonology (8%) and neurology (6%). As with foreign visitors, the elderly (ages 65+) are most likely to be hospitalized for heart ailments. People 18-64 years old, or “working age” are most likely to be hospitalized for general surgery (13%), usually an appendectomy or laparoscopic cholecystectomy (gall bladder removal). Finally, children are most often hospitalized as a consequence of being born while the parents were on vacation in Hawaii. Most of these births are normal newborns. (See Other views: Mainland visitor hospitalizations: by age group.)

• Psychiatric hospitalizations among foreign visitors are the single most notable difference between foreign and mainland visitors and between foreign visitors and Hawaii residents. The stress of lengthy airline travel and time zone changes may contribute to some of the psychiatric health problems of these visitors, as well as abuse of alcohol and drugs.
• Injuries leading to the need for orthopedic surgery might be preventable. What can we do to educate visitors regarding dangers?
• Air travel and illness are frequently associated, e.g., infectious diseases, respiratory illnesses, food poisoning. Chronic Obstructive Pulmonary Disease (COPD) patients face particular problems with air travel. Heightened attention to good hygiene, adequate hydration and current health status are essential.
• For those with chronic health conditions, advance knowledge of Hawaii-based healthcare providers is useful, as well as being prepared with documentation regarding prescriptions and over-the counter drugs currently being used.

• Looking for statistics?
• Heart Health and Men
• Obesity Heavy Burden on Hospitals
• Babies: NOT Cheaper by the Dozen!
• Meth Admissions Rising in Hawaii
• Hawai'i Rated "Average" in Providing Quality Healthcare