Distance as an obstacle to health care delivery in Indian Country

A story in the New York Times earlier this week proclaimed good news for American Indian health care in the form of stimulus dollars and other federal funds flowing to the Indian Health Service. Describing a meeting in Washington last month between Obama and the leaders of 564 tribes, Pam Belluck writes that health care was at the top of leaders' wish lists. Obama is quoted as acknowledging disparities in health care delivery for American Indians, and specifically the high rates at which this population die of a range of illnesses, e.g., diabetes, alcoholism, pneumonia, influenza, and even tuberculosis. Senator Byron Dorgan of North Dakota calls for an appropriate federal response to the “full-scale health care rationing going on on Indian reservations.”

While a great deal of the "rationing" described is due to lack of funding and staff shortages, the story also makes frequent mention of distance as an impediment to delivery of health care for Indians. Interestingly, it also provides two specific illustrations of challenges to Indian health care delivery in urban contexts. Here are some excerpts regarding rural locales and attendant spatial challenges:

Too few doctors. Too little equipment. Hospitals and clinics miles of hardscrabble road away.

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Money shortages, bureaucracy and distance can delay treatment of even serious conditions for months, even years.

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Treating large swaths of the Hopi and Navajo reservations — the Navajo alone is the size of West Virginia — is inherently difficult.

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Ruby Biakeddy’s six-sided hogan, a traditional Navajo home, without running water or a phone, is an hour’s drive on a dirt road from drinking water, and even farther from diabetes and blood pressure medication.

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Patients contribute to the frustrations. Nearly a third do not show up for scheduled surgery at Tuba City, often citing distance or cost.

Of course, better funding can alleviate some of these spatial challenges by enabling the provision of care in more places and with longer opening hours. Funding won't, however, solve all of the problems if, as Belluck observes, "providers and insurers, daunted by the alarming health problems, continue avoiding Indian Country."