Indian health service : basic services mostly available, substance abuse problems need attention: Report to Congressional requesters

Pursuant to congressional requests, GAO reviewed the availability of health care services to American Indians and Alaska Natives residing in five Indian Health Service (IHS) areas, focusing on: (1) the differences in health care delivery in the five areas; (2) the availability of basic health care services; and (3) major health care needs warranting additional attention.

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).