title: Access to specialty health care for rural American Indians in two states.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To examine specialty service access among rural Indian populations in two states.
  
  
  METHODS
  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%).
  
  
  RESULTS
  Substantial proportions of rural Indian clinic providers in both states reported fair or poor non-emergent specialty service access for 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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington 98195-4982, USA. lmb@fammed.washington.edu
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
authors.forename: Walter B
authors.initials: WB
authors.lastname: Hollow
authors.forename: Susan
authors.initials: S
authors.lastname: Casey
authors.forename: L Gary
authors.initials: LG
authors.lastname: Hart
authors.forename: Eric H
authors.initials: EH
authors.lastname: Larson
authors.forename: Kelly
authors.initials: K
authors.lastname: Moore
authors.forename: Ervin
authors.initials: E
authors.lastname: Lewis
authors.forename: C Holly A
authors.initials: CH
authors.lastname: Andrilla
authors.forename: David C
authors.initials: DC
authors.lastname: Grossman
mesh_terms: D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007198:Indians, North American; D008511:Medicine; D009009:Montana; D009516:New Mexico; D012424:Rural Population; D013038:Specialization