Access to specialty health care for rural American Indians in two states

  • Abstract


    The Indian Health Service (IHS), whose per capita expenditure for American Indian and Alaska Native (AI/AN) health services is about half that of the US civilian population, is the only source of health care funding for many rural AI/ANs. Specialty services, largely funded through contracts with outside practitioners, may be limited by low IHS funding levels.


    To examine specialty service access among rural Indian populations in two states.


    A 31-item mail survey addressing perceived access to specialty physicians, barriers to access, and access to non-physician clinical services was sent to 106 primary care providers in rural Indian health clinics in Montana and New Mexico (overall response rate 60.4%) and 95 primary care providers in rural non-Indian clinics within 25 miles of the Indian clinics (overall response rate 57.9%).


    Substantial proportions of rural Indian clinic providers in both states reported fair or poor non-emergent specialty service accessfor their patients. Montana’s rural Indian clinic providers reported poorer patient access to specialty care than rural non-Indian clinic providers, while New Mexico’s rural Indian and non-Indian providers reported comparable access. Indian clinic providers in both states most frequently cited financial barriers to specialty care. Indian clinic providers reported better access to most non-physician services than non-Indian clinic providers.


    Reported limitations in specialty care access for rural Indian clinic patients appear to be influenced by financial constraints. Health care systems factors may play a role in perceived differences in specialty access between rural Indian and non-Indian clinic patients.

  • Authors:

    Baldwin LM, Hollow WB, Casey S, Hart LG, Larson EH, Moore K, Lewis E, Andrilla CHA, Grossman DC

  • Journal/Publisher:

    J Rural Health

  • Edition:

    Jun 2008. 24(3):269-278

  • Link to Article

    Access the article here: J Rural Health

  • Citation:

    Baldwin LM, Hollow WB, Casey S, Hart LG, Larson EH, Moore K, Lewis E, Andrilla CHA, Grossman DC. Access To Specialty Health Care For Rural American Indians In Two States. J Rural Health. Jun 2008 24(3):269-278

  • Related Studies:

    Availability of Specialty Health Care for Rural American Indians (AIs) and Alaska Natives (ANs)