Indian Health Service

The five Indian Health Service area offices GAO visited--Aberdeen, Alaska, California, Navajo, and Portland--differed greatly in the way that they delivered health care services. Nonetheless, the areas reported generally similar levels in the availability of basic clinical services. The services most available were treatment services, such as routine prenatal care, and diagnostic services, such as biopsies for cancer diagnoses. Almost all patients seeking such services were able to receive them. Preventive care, such as diabetes education and dental care, was comparatively less available. Service unit officials generally named alcohol and substance abuse services as their greatest unmet health need. Despite recent increases in Indian Health Service funding for alcohol and substance abuse treatment services, the gap between the demand for and availability of services persists. In addition, the Indian Health Service lacks data on alcoholism rates among native Americans and the effectiveness of current prevention and treatment programs.

GAO found that: (1) two IHS areas provided most health care services through large medical centers, two areas relied on public or private contractors to provide essential services, and one service area provided hospital and contractor-provided care; (2) health care services, including basic medical and surgical treatment and diagnostic services, are generally available in all five areas, but the availability of preventive and dental care services is limited; (3) Indians do not utilize available preventive care services; (4) IHS officials are concerned that contract-care problems including funding limitations, procedural burdens, and restrictive eligibility criteria lessen the availability of some nonemergency services; (5) geographic isolation of the service population and the existence of alternate health programs such as Medicaid has affected the availability of services in many areas; (6) alcohol and substance abuse services and related mental health services are the greatest unmet health care needs in IHS service areas; (7) Congress has expanded IHS authority and increased funding for alcoholism and substance abuse prevention and treatment services; (8) IHS has no comprehensive data on the rates of alcoholism and substance abuse in Indian communities, tribal initiatives, or the effectiveness of IHS and tribal prevention and treatment programs; and (9) IHS is seeking funding for a study of alcohol and substance abuse in Indian communities and has discussed research needs with the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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