Honolulu, Hawaii
                                                     , 1999

                                   RE:  S.B. No. 837
                                        S.D. 1

Honorable Norman Mizuguchi
President of the Senate
Twentieth State Legislature
Regular Session of 1999
State of Hawaii


     Your Committee on Commerce and Consumer Protection, to which
was referred S.B. No. 837 entitled: 


begs leave to report as follows:

     The purpose of this measure is to allow patients direct
access to dermatologists without referral from a primary care
physician (PCP).  This measure would also require health care
plans that include dermatological coverage to reimburse the plan
participant or pay the provider for dermatological services
rendered regardless of whether a referral or authorization was
obtained prior to delivery of services.

     The Hawaii Federation of Physicians and Dentists, Hawaii
Dermatological Society, and two individuals presented testimony
in support of the measure.  The Hawaii Medical Services
Association and Kaiser Permenente presented testimony in
opposition to the measure.  The Insurance Commissioner presented
testimony in support of the measure with proposed amendments. 

     Your Committee finds that using PCP's as gatekeepers,
generally lowers the cost of health insurance and results in more
comprehensive care being provided in the most cost-effective
manner.  However, if the use of PCP's as gatekeepers, endangers
the quality of health care services offerred, then direct access
to a medical specialist should be available for consumers. 

                                   STAND. COM. REP. NO. 790
                                   Page 2

     Your Committee further finds that a recently published study
at one of the leading medical centers revealed that the working
diagnosis of skin disease by non-dermatologists was incorrect in
68% of the patients.  In the case of skin cancer, error or even
delay in detection and proper treatment could be fatal. 

     Your Commitee further finds that direct access to
dermatologists will not increase the overall costs of medical
care.  Because dermatologists offer faster, more accurate
diagnosis and superior knowledge of the best available
treatments, the consumers will need to make fewer visits,
resulting in less lost time from work, in addition to a generally
higher quality of service.

     Your Committee has amended this bill by deleting the section
that addresses fraternal benefit societies, because fraternal
benefit societies in Hawaii do not offer health insurance to
their members.

     As affirmed by the record of votes of the members of your
Committee on Commerce and Consumer Protection that is attached to
this report, your Committee is in accord with the intent and
purpose of S.B. No. 837, as amended herein, and recommends that
it pass Third Reading in the form attached hereto as S.B. No.
837, S.D. 1.

                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Commerce and
                                   Consumer Protection,

                                   BRIAN KANNO, Co-Chair

                                   BRIAN T. TANIGUCHI, Co-Chair