There is no question that the Indian Health Service has problems delivering quality care to patients. Senator Rounds, a legislator who has long criticized the IHS, has introduced legislation requiring HHS to conduct an independent audit.
Rounds has identified three major areas of concern: the lack of a funding strategy, lack of a standard of quality measurement for care, and high staff turnover resulting in impaired management accountability. A similar audit was done with regard to the VA health system about four years ago, and this is Senator Rounds’ rationale for the legislation.
While this legislation certainly seems reasonable, saying it will lead to improvements is naïve if you are reaching that conclusion based on the experience with the VA. Like the IHS, the VA has been plagued with huge quality concerns. To say the VA’s care is inconsistent is a charitable assessment. Four years ago, huge attention was focused on the VA arising from the “wait lists” scandals. Legislation was passed. The stories – some of them lurid – were all over the media. Four years later, has the quality of VA care markedly improved? Based on our observations and our keeping up with the topic, it does not look that way. And I challenge anyone to demonstrate that it really has improved.
With this in mind, why should we think that an audit of the IHS will lead to marked improvements? I am dubious. I suppose that because the IHS is much smaller than the VA, there is a better chance of turning it around. However, to do so one needs to do more than just identify the problems. While that is a necessary first step, the much harder part is devising and implementing a plan for improvement. The VA has had its problems brought to light, but so far it is still not making the necessary changes. Let’s hope the Indian Health Service is different. I wish I could say I am optimistic.