“Healthy Alaskans 2020”, http://hss.state.ak.us/ha2020 a statewide collaborative, sponsored by the Alaska Department of Health and Social Services http://dhss.alaska.gov/dph, Alaska Native Tribal Health Consortium www.anthctoday.gov (ANTHC), and funded by CDC’s National Public Health Improvement Initiative www.cdc.gov/stltpublichealth/nphii is working to upgrade healthcare in the state.
The State has some unique problems in providing healthcare to the majority of the population. Alaska is an extreme frontier state with 1.2 persons per square mile spread throughout 262 communities. The result is that the state population of 731,449 is spread across an area larger than California, Texas, and Montana combined which is equal to one-fifth the landmass of the U.S.
One quarter of the population lives in communities with less than 2,500 people which means that about 200 villages are reachable only by air or boat along Arctic rivers, coastline, and islands, therefore transporting medicines and other supplies is very difficult and supplies must be brought in by airplanes, helicopters, boats, or barges.
The result is that Alaska provides challenges to providing public health and preventive services due to its highly dispersed population, high transportation costs, and limited local public health infrastructure.
In addition, the state has a very diverse young population with only 8.7 percent of the population older than 64. However, the age 65 or older population is expected to increase rapidly over the coming decades and is estimated to reach 14.5 percent of the population by 2034.
About 13.6 percent of the population and 18.6 percent of those under 18 years live below 125 percent of the federal poverty level. Twenty one percent of all Alaskans are without health insurance coverage as compared to 15 percent in the U.S. Thirty percent of adults do not have one person they consider their personal healthcare provider and 15 percent report being unable to seek healthcare service in the past 12 months due to cost.
The three systems providing healthcare in Alaska includes the private sector, the military, the Veterans Administration health system, and the Alaska Tribal Health System www.alaskatribalhealth.org. Alaska is unique as it is the only state that does not have any managed care organizations in the private sector and formal provider networks are scarce.
The private sector is defined as any services provided outside of the military or tribal systems and includes hospitals (both non-profit and for-profit), physician offices, dentists, mental health professionals, and Federally-Qualified Health Centers. Limited public health services are provided by State Public Health Nurses at clinics.
The Alaska VA Healthcare System www.alaska.va.gov offers primary, specialty, and mental health outpatient care. Services are provided through a joint venture with the U.S. Air Force at Elmendorf Air Force Base as well as through purchased care arrangements with community hospitals. Outpatient services are also provided at community-based outpatient clinics.
American Indian/Alaska Native tribal members generally have access to tribal health services even if they do not have healthcare coverage. The Alaska Native Tribal Health Consortium (ANTHC) www.anthc.org provides a wide range of high quality health services to more than 140,000 Native and American Indian people.
ANTHC offers statewide services in tertiary and specialty medical care, water and sanitation, community health and research, information technology, and offers professional recruitment for tribal health partners.
ANTHC manages the Alaska Native Medical Center http://anmc.org which is a non-profit health center that provides medical services and is jointly owned and managed by ANTHC and the Southcentral Foundation www.southcentralfoundation.com as well as by tribal governments and regional organizations.
ANTHC has developed a new electronic manual eCHAM to help Community Health Aides and Practitioners (CHAP) www.akchap.org/html/home-page.html. eCHAM will become available so that healthcare workers can access the electronic manual via the web using tools like computers, iPads, or other tablet and mobile devices. Currently, eCHAM is being tested and expected to be released soon.
Telemedicine and telehealth has developed in the state and will continue to advance. The Alaska Federal HealthCare Access Network (AFHCAN) www.afhcan.org is a program within ANTHC that designed and developed an innovative store-and-forward telehealth solution called tConsult to connect providers to patients in remote locations. AFHCAN has also developed mobile Telemedicine Carts that are used throughout Alaska and elsewhere.
Legislatively, telemedicine has been expanded to provide Alaskans even more access to telemedicine. House Bill 281 passed in March allows patient to have phone or online consultations with physicians for diagnostic purposes and also receive prescriptions.