Indian Health Service:

Basic Services Mostly Available; Substance Abuse Problems Need Attention

HRD-93-48: Published: Apr 9, 1993. Publicly Released: May 12, 1993.

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Mark V. Nadel
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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).

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: In its response, HHS stated that the Department concurred with GAO's recommendation and had approved a corrective action plan developed by IHS to address the findings and the recommendation contained in the GAO report. As recommended by GAO, IHS's plan includes collaboration with NIH, SAMHSA, and other federal agencies to address the need for research and evaluation on the prevalence of alcohol and substance abuse among Indians and the nature and effectiveness of prevention and treatment programs available to Indians. IHS has also set aside $300,000 in FY 1993 to support a study of its regional treatment centers. Future budget recommendations will reflect further attention to ongoing data needs.

    Recommendation: To ensure that limited federal resources are put to the best possible use in addressing the serious problem of alcohol and substance abuse in IHS service areas, the Secretary of Health and Human Services should ensure that the directors, IHS, NIH, and SAMHSA collaboratively develop a plan and identify potential sources of funds to collect and evaluate data on: (1) the prevalence of alcohol and substance abuse among Indians; and (2) the nature and effectiveness of alcohol and substance abuse prevention and treatment programs available to Indians in IHS areas.

    Agency Affected: Department of Health and Human Services


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