A new hospital won’t fix Guam’s healthcare; rethinking the model will

By Dr. Michael Cruz

Once again, Guam Memorial Hospital is making headlines—and not for positive reasons. The latest developments underscore what healthcare professionals have long known: Guam’s healthcare crisis is rooted not in buildings or equipment, but in governance, accountability and sustainability.

This crisis is largely of the public sector’s own making, centered on GMH and the Department of Public Health and Social Services. Meanwhile, the private sector continues to deliver quality care despite chronic neglect and a lack of meaningful government support.

It has become a political refrain: “Guam needs a new hospital.” While modern facilities are important, this narrative misses the point. A new hospital should and will be part of Guam’s healthcare future. But if it is run under the same failing governance structure, it will inherit GMH’s long-standing problems.

Gov. Lou Leon Guerrero has publicly and privately expressed support for a public-private partnership model for healthcare. That model must not be an afterthought—it must be implemented alongside, or even before, the construction of any new hospital. Without this shift, millions could be spent on a new building that quickly falls into the same dysfunction.

The private healthcare sector proves that another path is possible. The Shieh Clinic, Guam Radiology Consultants, Guam Surgicenter, American Medical Center, FHP Health Center and the Seventh-day Adventist Clinic—along with Guam’s only private hospital—have maintained accreditation, invested in technology, and recruited skilled staff, all while serving the same patient population as GMH. 

A worn, false narrative persists: that GMH’s financial problems stem from being the only hospital required to treat all patients, regardless of ability to pay. In truth, Guam’s only private hospital treats all who walk in (except for non-emergency maternal-child healthcare, which it does not provide) and remains financially stable. The difference lies not in the patients, but in governance, management and accountability.

My own experience bears this out. As lieutenant governor, I led the successful effort to restore GMH’s accreditation after nearly 30 years without it. I was also involved in the planning, opening, and accreditation of the island’s only private hospital. The lesson was clear: government-run healthcare fails not because of dedicated frontline workers, but because of systemic mismanagement.

Equally troubling is a growing disconnect between policymakers and healthcare professionals. During debate over amending Guam’s Mandatory Arbitration Act, one senator told healthcare providers: “They need to do what they do best and that’s health care, and we do what we do and that’s policy. So I think they need to kind of dial it down.” Another senator publicly tried to intimidate a young medical student during testimony—not to gain insight, but to dismiss his concerns.

This mindset is dangerous and arrogant. Healthcare is policy. Every law passed impacts how medicine is practiced, how patients receive care, and how the system functions. Silencing healthcare professionals undermines the very expertise needed to craft effective legislation.

A PPP model offers Guam its best chance for sustainable, high-quality healthcare—financially efficient, insulated from politics, and grounded in performance-based accountability. I believe that the government of Guam should remove itself from the business of managing healthcare. The government’s role should be to regulate, fund, and ensure equitable access, while healthcare professionals and organizations manage operations.

The bottom line: Guam can build a new hospital, but without reforming how healthcare is governed, we’ll simply put old problems into new walls. The time to implement a new model is now—before the first brick is laid.

Michael W. Cruz, MD, MBA, FACS, served as lieutenant governor of Guam from 2007–2011. He is a surgeon, former senator, and was instrumental in restoring GMH’s accreditation and in the opening and accreditation of Guam’s only private hospital.

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