Access Barriers to Primary Health Care: Indigenous People and the Role of the Physician Assistant in Northern Manitoba
Date
2015-04
Authors
Barnes, Christopher
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Abstract
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.