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GAO report finds IHS care subject to limits, rations

GAO Report Excerpt:
Comparison of Aberdeen, Oklahoma City and Portland Areas

Indianz.Com Listening Lounge, Senate Indian Affairs Committee hearing on Indian Health Care Improvement Act, July 14, 2005:
Note: The following files are in MP3 format.
Intro - 8:27 - 1.45MB

Dr. Grim - 9:39 - 1.66MB | Q&A - 30:15 - 5.19MB

Panel II - 31:20 - 5.38MB | Q&A - 14:56 - 2.56MB

Panel III - 18:47 - 3.22MB | Q&A - 30:17 - 5.20MB
Witness List / Testimony
American Indians don't always receive the health services they need and in some cases are subject to rationed care, the Government Accountability Office said in a new report.

Based on a study of 13 facilities in the lower 48 states, Congressional investigators found that the Indian Health Service (IHS) offers a wide range of primary care to tribal members. But access to medical, dental, and vision services wasn't always guaranteed due to long waiting times, travel distances and lack of transportation, the GAO said.

"For example, waiting times at 4 IHS-funded facilities ranged from 2 to 6 months for certain types of appointments, and 3 IHS-funded facilities reported that some Native Americans were required to travel over 90 miles one way to obtain care," the report issued September 30 stated.

For care beyond the basics, the GAO found that IHS facilities generally offered certain ancillary and specialty services such as x-rays and obstetrics/gynecology. But due to limits in funding, staff and other resources, tribal members don't always get the help they need even under contracts with outside facilities, the report said.

"Ancillary and specialty services that were unavailable on site or at other IHS-funded facilities could be obtained only through contract care, which was rationed by 12 of the 13 facilities on the basis of relative medical need," the GAO reported.

According to the GAO's analysis, IHS regulations limit the use of contract health services. A patient must satisfy five criteria before even being considered for specialty services.

But eligibility doesn't always guarantee care, the report noted. Based on a priority system that is divided into five levels, the IHS isn't required to pay for certain types of services. This means a woman could go without prenatal care or an elder could go without nursing care.

"For example, tribal health board members at one facility described the case of an elderly woman who had complained of back pain and was diagnosed with cancer only when one of her legs broke," the report stated. "Tribal representatives at another facility cited the example of a young man whose lung condition was only properly diagnosed when, after months of treatment for pneumonia, he went to an emergency room and was found to have a tumor that killed him 3 weeks later."

The system is somewhat complicated because each of the 12 IHS areas can set its own priority levels. Tribes that operate health facilities under self-determination or self-governance agreements can set their own priorities as well. A lack of funds also affects whether a patient receives care, the GAO added.

"Facility officials said that demand for contract care could affect where they drew the line between services that met medical priority criteria and those that did not," the report stated. "For example, one facility reported that the definition of emergent and acutely urgent services narrowed over the course of the year as contract care funds were depleted."

Despite some of the negative findings, IHS "substantially" agreed with the GAO. In an August 1 letter, Dr. Charles Grim, a member of the Cherokee Nation, offered just a few recommendations and changes to the report.

The GAO delivered its findings to Sen. John McCain (R-Arizona) and Sen. Byron Dorgan (D-North Dakota), the leaders of the Senate Indian Affairs Committee. The committee requested the report and have been leading efforts to renew the Indian Health Care Improvement Act, which seeks to raise the health status of American Indians and Alaska Natives.

The bill has been tied up due to objections from the Bush administration. Former Health and Human Services Secretary Tommy Thompson, who was Grim's boss, promised to work with the committee back in July 2004 but nothing major happened.

In July, McCain and Dorgan joined a slate of tribal leaders in seeking passage of the bill. It is due to be considered at a business committee meeting next week on Thursday, October 20.

Get the Report:
Health Care Services Are Not Always Available to Native Americans (September 30, 2005)

Get the Bill:
Indian Health Care Improvement Act Amendments of 2005 (S.1057)

Relevant Links:
Indian Health Service -
National Indian Health Board -