Health Care Access

In 1992, about 22 million Americans lived in areas with shortages of doctors. Some experts have suggested that greater use of nonphysician providers could expand access to health care. Recent studies have shown that up to 90 percent of the diagnoses made in outpatient settings could be handled capably by physician assistants or nurse practitioners. Under a unique program sponsored by the Indian Health Service, Alaskans have been trained to provide emergency and primary care in remote villages that are sometimes hundreds of miles away from the nearest doctor. These individuals rely on procedures spelled out in an easy-to-read manual and consult daily by telephone or radio with a hospital-based doctor. Available data indicate that the program has generally been well-accepted by patients and that it has significantly improved the health status of Alaska natives. The federal government has assumed responsibility for any medical malpractice claims arising from the program. Pinellas County, Florida, has studied the Alaska program and has proposed a plan under which paramedics would provide primary care to medically needy persons during off-peak hours, following strictly defined procedures and consulting electronically with hospital-based physicians. Whether such a program can get off the ground is unclear because current laws do not allow paramedics to provide routine primary care services and because it is unclear who would assume medical liability for such paramedic services.

GAO found that: (1) the Alaskan program trains community health aides (CHAS) to provide emergency and primary care in villages that do not have access to a physician; (2) CHAS use set treatment procedures and consult daily with hospital-based physicians by telephone or radio; (3) in 1991, CHAS served about 45,000 Alaska Natives and handled more than 253,000 patient inquiries; (4) although the program's effects have not been adequately measured, IHS believes the program has contributed to the improved health status of Alaska natives; (5) the government assumes responsibility for medical malpractice claims against CHAS; (6) although Florida has proposed using key aspects of the Alaska program to increase medical access in an urban setting, it will use paramedics to provide primary care during off-peak hours and require them to follow strictly defined procedures and consult with hospital-based physicians electronically; and (7) Florida must resolve whether current state laws prohibit paramedics from providing primary care and who will assume medical liability responsibility before it can implement the program.