The Healthcare Association of Hawaiçi estimates that the state's hospitals and nursing homes lost $150 million in 2005, mostly from bad debt, charity care and the cost of keeping patients at hospitals because of a lack of long-term care beds.

The estimate was part of a briefing Monday afternoon for the state Senate Health Committee and the House Health Committee, which are considering bills to help hospitals and nursing homes.

Asked by state Rep. Josh Green, D-6th (N. Kona, Keauhou, Kailua-Kona), the chairman of the House Health Committee, to rank the top issues facing the industry, Rich Meiers, president and chief executive officer of the association, pointed to reimbursement and capacity issues.

Doctors have complained about inadequate reimbursement from the state and federal governments and private insurers for patient care. A waiting list for nursing home beds, meanwhile, is costing hospitals millions and has forced one, The Queen's Medical Center, to send some patients to the Mainland for long-term care.

Green asked Meiers to provide an estimate of the cost of higher medical malpractice insurance premiums and malpractice lawsuits, which have been cited as a factor in the shortage of medical specialists in some parts of the state.

The Lingle administration, and many in the healthcare industry, have urged lawmakers to pass malpractice reform legislation this session. But some lawmakers have asked what impact reform — such as a cap on non-economic damages — will have on issues such as access to healthcare.