Examining the CNMI’s Ongoing Healthcare Gaps
Erin Ferrer | erin.ferrer@my.marianas.edu
Northern Marianas College
Acknowledgements
Project lead: Connor Flynn
Mentors: Lela Gi and Clara Slate-Liu
Introduction
Healthcare access in the Commonwealth of Northern Marianas Island (CNMI) is shaped by many challenges, including provider shortages, limited specialty services, and heavy reliance on off-island medical referrals. Over time, these challenges have affected the quality, affordability, and continuity of care available to island residents. Although CNMI’s population has declined since 2000, recent data shows that demand for healthcare services has grown significantly. I explored how healthcare access in the CNMI has evolved by examining four key indicators: changes in population size, the total number of patient visits recorded by CHCC, the most common reasons for off-island referrals, and the percentage of healthcare needs met based on the CNMI’s Health Professional Shortage Area (HPSA) designation. These help illustrate how service demand is outpacing available resources and emphasizing the importance of workforce and infrastructure investments in supporting healthcare equity across the islands.
Research Question
How has healthcare demand in the CNMI changed over time, and what gaps in care contribute to off-island referrals?
Discussion
The data highlights ongoing challenges in the CNMI healthcare system. While the population has declined, CHCC recorded over 121,000 patient visits in 2023 which is nearly four times the average from 2013 to 2017. This increase suggests that healthcare demand is being driven by chronic conditions and service gaps in addition to the population decreasing. The most common off-island referrals, which are cardiology, ophthalmology, MRI, and oncology, reflect the lack of local specialty care. CNMI currently meets only 82% of its primary care need and still requires three more practitioners. These findings emphasize the need to expand local services and invest in the healthcare workforce to reduce referral burdens and improve access.
Conclusion
Despite a declining population, healthcare demand in the CNMI continues to rise. Limited specialty services and workforce shortages have led to increased patient visits and high off-island referral rates. Addressing these gaps will require expanding local services, strengthening the provider workforce, and investing in sustainable, community-based solutions.
Results
Methods
This research used public datasets and institutional reports to examine healthcare access in the CNMI. Sources included the CHCC Strategic Plan, Medical Referral Services data, CNMI Statistical Yearbook, the CNMI Census, and peer-reviewed research from the Hawai‘i Journal of Medicine & Public Health.
Data processing and visualization were done using Python in Jupyter Notebook, with support from the TACC Stampede3 supercomputing platform. The TACC Portal was used for secure project access and data storage. ChatGPT was used to assist with Python coding and visualization formatting.
References
Next Steps
To better meet the healthcare needs of CNMI residents,we should expand in-island specialty services, which would reduce the need for costly and disruptive off-island referrals. Recruitment and retention of qualified healthcare professionals must also remain a top priority, especially for remote areas like Tinian and Rota. Additionally, further research should be conducted to check the outcomes of off-island referrals, as well as to explore barriers such as transportation, language access, and trust in care.
Examining the CNMI’s Ongoing Healthcare Gaps
Erin Ferrer | erin.ferrer@my.marianas.edu
Northern Marianas College
Acknowledgements
Project lead: Connor Flynn
Mentors: Lela Gi and Clara Slate-Liu
Introduction
Healthcare access in the Commonwealth of Northern Marianas Island (CNMI) is shaped by many challenges, including provider shortages, limited specialty services, and heavy reliance on off-island medical referrals. Over time, these challenges have affected the quality, affordability, and continuity of care available to island residents. Although CNMI’s population has declined since 2000, recent data shows that demand for healthcare services has grown significantly. I explored how healthcare access in the CNMI has evolved by examining four key indicators: changes in population size, the total number of patient visits recorded by CHCC, the most common reasons for off-island referrals, and the percentage of healthcare needs met based on the CNMI’s Health Professional Shortage Area (HPSA) designation. These help illustrate how service demand is outpacing available resources and emphasizing the importance of workforce and infrastructure investments in supporting healthcare equity across the islands.
Research Question
How has healthcare demand in the CNMI changed over time, and what gaps in care contribute to off-island referrals?
Discussion
The data highlights ongoing challenges in the CNMI healthcare system. While the population has declined, CHCC recorded over 121,000 patient visits in 2023 which is nearly four times the average from 2013 to 2017. This increase suggests that healthcare demand is being driven by chronic conditions and service gaps in addition to the population decreasing. The most common off-island referrals, which are cardiology, ophthalmology, MRI, and oncology, reflect the lack of local specialty care. CNMI currently meets only 82% of its primary care need and still requires three more practitioners. These findings emphasize the need to expand local services and invest in the healthcare workforce to reduce referral burdens and improve access.
Conclusion
Despite a declining population, healthcare demand in the CNMI continues to rise. Limited specialty services and workforce shortages have led to increased patient visits and high off-island referral rates. Addressing these gaps will require expanding local services, strengthening the provider workforce, and investing in sustainable, community-based solutions.
Results
Methods
This research used public datasets and institutional reports to examine healthcare access in the CNMI. Sources included the CHCC Strategic Plan, Medical Referral Services data, CNMI Statistical Yearbook, the CNMI Census, and peer-reviewed research from the Hawai‘i Journal of Medicine & Public Health.
Data processing and visualization were done using Python in Jupyter Notebook, with support from the TACC Stampede3 supercomputing platform. The TACC Portal was used for secure project access and data storage. ChatGPT was used to assist with Python coding and visualization formatting.
References
Next Steps
To better meet the healthcare needs of CNMI residents,we should expand in-island specialty services, which would reduce the need for costly and disruptive off-island referrals. Recruitment and retention of qualified healthcare professionals must also remain a top priority, especially for remote areas like Tinian and Rota. Additionally, further research should be conducted to check the outcomes of off-island referrals, as well as to explore barriers such as transportation, language access, and trust in care.