Executive summary: western Nevada health systems delivery study.

This document is a summary of the Western Nevada Health Delivery Study. The geographic area addressed by this study is known as the Schurz Service Unit of the Phoenix Area Indian Health Service (IHS). The target population (12 Tribes) consists of the Indians residing within this area. Three main purposes of this study were to: 1) assess the total health care needs of the Indians in western Nevada; 2) set area-wide goals aimed at satisfying those needs; and 3) develop a phased strategy for moving from the present situation to the desired improvements. Based on initial data analyses. Five alternative health care delivery designs that would adequately provide for the projected demand for future health care services were developed and presented to the Tribal Task Force for consideration. The alternative designs were evaluated with reference to several factors: 1) agreement with Tribal and Urban Specific Health Plans; 2) travel time; 3) potential for recruitment of health care staff; 4) projected utilization; and 5) potential cost savings. The design that was selected by the Tribal Task Force formed the basis for the Master Health Plan that was then developed. The prioritization was completed by a process that involved a preliminary listing of priorities: 1) a discussion among Tribal Task Force and Tribal Council members of the preliminary listing; and 2) a vote on a final ranking of priorities by the Task Force members. The final set of priorities voted on by the Tribal Task Force formed the basis for the Implementation Plan. This Final Report of the study documents that the scope of direct IHS health care services is deficient in meeting the health care needs of the Schurz Service Unit Population. In addition, the report documented the significant shortcomings of the present Contract Health Services (CHS) system. The low utilization rate reported for the Schurz Service Unit is largely due to two factors: 1) recent decreases in CHS utilization related to increasing cost per health service and limited CHS funding; and (2) the unavailability and inaccessibility of direct ambulatory care services. On the other hand, the general outline for the proposed optimal health care delivery system for Western Nevada (developed on the basis of the systems analysis) contains the following main components: 1) Outpatient Care; 2) Inpatient Care; 3) Field Health Services and Tribal Health Programs; and (4) Dental, Optometric, and Audiologic services. The system of decentralized ambulatory health facilities outlined has the following characteristics: 1) It is acceptable to most of the Tribes in Western Nevada as it generally coincides with the recommendations of the Tribal and Urban Specific Health Plans; 2) It is a system in which 88.5% of the Indian population is accessible to one of the ambulatory health centers; 3) Accessibility to health care is greatly improved for the majority of the population; 4) Each proposed facility provides a visible and clearly defined point of entry into the system, enabling Indians to receive services for all their health care needs; 5) Each proposed facility is a base for dispensing a comprehensive range of care either through direct service or through referral; 6) There is the possibility of increased control of inpatient utilization because of increased IHS physician access to local hospitals. The study makes detailed recommendations on facility, equipment and personnel requirements for an optimal area-wide health care delivery system. Recommendations are linked to the IHS Resource Allocation Criteria (RAC)