Health care services provided by IHS to American Indians and Alaskan Natives are not a federal health care entitlement. In subsequent discussions with subcommittee staff, we agreed to focus our review on two areas: IHS’ efforts to ensure that temporary physicians working in IHS facilities are qualified and competent to perform assigned duties, and what happens when requested medical services are delayed. Instead, IHS requires only that a physician have a medical license without restrictions to practice medicine. IHS Contracts Do Not Always Require That Information Be Shared

IHS facilities generally do not include a requirement in their contracts with locum tenens companies to (1) verify all licenses that a physician may hold, (2) inform IHS of the status of all licenses, and (3) provide all performance and disciplinary data that they may have on a temporary physician. As a result, IHS does not always obtain complete credentials information and is not always aware of temporary physicians with performance or disciplinary problems. At present, IHS facilities do not have a formal mechanism to share information on the performance of temporary physicians who have worked in the IHS system. The result is reduced access to contract medical services for American Indians and Alaskan Natives. However, he is concerned about how scheduled staff reductions after fiscal year 1996 may affect IHS’ delivery of medical services and its expansion program. Contract Health Services Funds Used to Purchase Care From Non-IHS Providers

IHS distributes contract health services funds among its 12 area offices based primarily on the level of funding that the area received in previous years.
Why GAO Did This Study

Pursuant to a congressional request, GAO provided information on American Indians' access to quality health care services, focusing on the: (1) Indian Health Service's (IHS) efforts to ensure that temporary physicians working in IHS facilities are qualified and competent to perform assigned duties; and (2) extent that medical services are delayed under the IHS Contract Health Services Program.

What GAO Found

GAO found that: (1) IHS patients may be receiving substandard care because IHS is not always aware of temporary physicians who have had performance or disciplinary problems; (2) although IHS requires that temporary physicians possess a current medical license without restrictions, it fails to verify all of the physicians' current or prior licenses; (3) most IHS facilities have contracts with companies that are not required to inform IHS of the status of their physicians' licenses; (4) IHS facilities do not possess a network to share information on the performance of its temporary physicians; (5) although IHS can purchase specialized medical services from non-IHS providers under the Contract Health Services program, preventive care is not always funded; and (6) IHS is implementing legislatively required staff reductions, however, officials are unsure of how these reductions will impact future medical services or expansion programs if appropriations are reduced as well.