Health Care Access:

Innovative Programs Using Nonphysicians

HRD-93-128: Published: Aug 27, 1993. Publicly Released: Sep 14, 1993.

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Pursuant to a congressional request, GAO provided information on innovative programs that use nonphysician providers to increase public access to health care, focusing on: (1) the method used by the Indian Health Service (IHS) to deliver emergency and primary care to remote areas; and (2) Florida's integration of the program into a medically underserved urban setting.

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.

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