Alaska ranks nearly last in the nation in terms of the number of providers compared to the number of patients. To complicate matters almost all doctors and virtually all specialty care is limited to Anchorage and Fairbanks. The lack of long term care options, the shortage of acute care providers, and the high turnover of providers in the state of Alaska challenge our federal and tribal partners to provide needed long term care and chronic disease management throughout our healthcare delivery area, particularly in remote rural areas.
In addition to the shortage of health care providers, there are significant barriers to receiving care with over 70% of Alaska not accessible by road. Airfare cost to receive routine care is very expensive. The cost of medical evacuation is exorbitant; with the average cost of a fixed wing evacuation exceeding $22,000.00. If a helicopter is required, the cost increases dramatically. To make things worse, air travel during the harsh winter months, including for medical evacuation is often not possible due to severe weather limitations.
Statistics show that seven out of ten Alaskans die from chronic disease. A conservative estimate is that 10 percent or over 27,600 federal healthcare beneficiaries in Alaska suffer from chronic disease and could substantially benefit from home telehealth monitoring. It has been proven that access to chronic disease management /education increases the patient’s quality of life, improves patient outcomes, reduces co-morbidities, reduces emergency room visits, re-admission rates, and eliminates the need for many medical Evacuations, and substantially reduces the total cost of health care. The federal health care system in Alaska cannot adequately provide coordinated care to manage all patients with chronic disease due to the limited number of providers and the daunting barriers to receiving healthcare. Thus, a robust telehealth system is needed to provide a lifetime of chronic disease management/education to our federal beneficiaries.
Few people from outside Alaska realize the vastness of the state’s 586,412 square miles. If one were to split Alaska in half, making each half its own state, Texas would still be only the third largest state. A map of Alaska, placed over a map of the continental United States of the same scale, shows Alaska stretching from Tallahassee, FL to San Diego, CA (2300 miles east to west), and from near the Canadian border to Dallas Texas, (1420 miles north to south).
The population of Alaska in 2008 was estimated at 686,293. That’s a little more than one person per square mile. The population of Alaska is younger than the rest of the United States, with approximately 26.2% under the age of 18 (U.S. average 24.3%), and less than 7.3% of the state’s population over the age of 65 (U.S. average 12.8%).
Alaska’s Healthcare Professionals
· 1,347 physicians in AK
· 2.05 per 1,000 population
· Below national ratio of 2.38
· Ratio of 2.62 needed
· Shortage greatest in internal medicine, medical subspecialties, and psychiatry
About 80% of all of these providers practice in and near Anchorage, meaning the 300 or so remaining physicians are sprinkled across the state’s remaining half million square miles. Alaska providers have resisted HMO development, and as a result Alaska is the only state in the union with no HMO plans for healthcare consumers.
Alaska’s Climate and Terrain
Although Alaska is well known for its winters where temperatures have dipped as low as –80°F, temperatures in the interior of Alaska can top 100°F during the summer months. This extreme climate range makes construction and transport challenging. Also, due to its northern latitude, much of the state experiences 24- hour daylight in the summer and 24- hour darkness in the winter, further challenging construction and transportation tasks. Alaska’s immense size, coupled with North America’s highest mountain ranges and huge glacier fields, make the cost of building roads prohibitive in much of the state, particularly the hundreds of outposts, small villages and towns in rural Alaska. The lack of roads and transportation infrastructure makes access to both urgent and routine medical care difficult.
The distance to supply centers cost of transportation, and relatively small buying power of a small population all add up to high costs in Alaska for goods and services. Although in recent years the high costs of many goods have shifted more towards the U.S. average, health care costs in Alaska are still approximately 25% higher than the U.S. average, with wide variations between different products and services. Hospital care costs are greater than 40% higher than the rest of the U.S. The federal government spent 31% of the $5.3 billion in total health care costs for the state of Alaska.