Access Barriers to Primary Health Care: Indigenous People and the Role of the Physician Assistant in Northern Manitoba

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Barnes, Christopher
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This capstone project compares Manitoba and Alaska health care reform policy in the context of northern Indigenous Health. Additionally, this paper compares northern Manitoba and Alaska Physician Assistant utilization rates. Two questions are investigated: (i) ) Will the current primary care reform policy improve access barriers to primary care for northern and remote Indigenous communities in Manitoba and if not, what other options might be available? (ii) Are Physician Assistants utilized within northern and remote Indigenous communities in Manitoba to address current service delivery challenges? Indigenous people in Manitoba experience significant health inequities as reflected in health indicators published in government documents and academic papers. Despite Manitoba’s primary care reform policy and in light of a recent Auditor-General’s report on northern health care, current systems do not appear to be addressing these issues and access barriers exist. A review of the literature using internet search engines by key words was performed. Important government and health websites were reviewed. Key informants were sought who had expertise in Indigenous health care, health system reform and current Physician Assistant policy and training. The topics examined were: Indigenous sociopolitical perspective, the effects of racism and colonization on Canadian Indigenous people, current health care issues and health care reform initiatives in Manitoba. The following are four significant findings of this study: (i) it is not yet known if current primary health care reform policy will improve access barriers for northern and remote Indigenous communities in Manitoba due in part to the complexity of the federal/provincial/Indigenous peoples arrangement and because there is no pre or post data for the selected health indicator (ii) an option called the “Nuka System of Care” exists, is culturally relevant, is structured to address access barriers related to jurisdictional discrepancies and staffing shortages and has resulted in better health for the Alaska Natives (iii) there is evidence that Physician Assistants are underutilized to address service delivery challenges within northern and remote Indigenous communities in Manitoba (iv) both the “Nuka” system and Physician Assistants could help address access barriers and service delivery challenges for northern and remote Indigenous communities in Manitoba if adopted but further research and evaluation would be needed before policy change could occur.