October 1, 2022

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Coast Guard Health Care: Improvements Needed for Determining Staffing Needs and Monitoring Access to Care

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<div>What GAO Found The U.S. Coast Guard (Coast Guard) staffs its clinics and sickbays with Coast Guard enlisted personnel and officers, who primarily serve as health service technicians and physician assistants, as well as with U.S. Public Health Service officers, including physicians and dentists. In addition, the Coast Guard uses a contract to fill some of its vacancies and augment other health care staff roles. As of July 2021, Coast Guard data show the service had 1,022 Coast Guard, Public Health Service, and contracted health care staff serving its health services program of clinics and sickbays. U.S. Coast Guard Health Care Staff by Source, as of July 2021 Note: U.S. Public Health Service Commissioned Corps are public health professionals that serve in federal agencies. The Coast Guard generally fills positions for its clinics and sickbays based on historical staffing levels. However, the current staffing approach does not address surge deployments of health care staff for missions away from clinics, such as to respond to hurricanes. Deployments have nearly quadrupled from 4,111 days in 2018 to more than 16,000 days in 2021, according to the service's data. Coast Guard officials expressed concern with difficulties in maintaining already burdened clinic operations when health care staff are deployed, which can result in clinics deferring services. Implementing staffing standards for its health services program that account for surge deployments would help ensure the Coast Guard is best targeting its resources to meet mission needs. To monitor access to care, the Coast Guard relies on each of its clinics to manually estimate access by counting the number of days to the next available appointment. However, Coast Guard officials stated that this approach does not produce reliable information on whether the Coast Guard is meeting its access-to-care standards. Coast Guard officials said they hope to collect system-wide data on access to care using a new electronic health record system. The Coast Guard expects to complete the system's initial rollout by September 2022, but officials have not yet determined how to use the system to monitor access. While the service works to better understand the capabilities of the new system, improving its process to collect more reliable access data will allow the Coast Guard to more accurately monitor whether its clinics and sickbays are meeting its access standards. Why GAO Did This Study In support of its maritime safety, security, and environmental stewardship missions, the Coast Guard—a military service within the Department of Homeland Security (DHS)—is tasked with providing health care to its approximately 47,000 active duty and reserve personnel. The Coast Guard offers certain outpatient medical and dental services to its personnel through 43 outpatient clinics and 122 sickbays, which are small facilities typically staffed by a health technician. The William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021 required GAO to review the Coast Guard health care system. This report examines how the Coast Guard 1) staffs its clinics and sickbays, 2) determines its staffing needs, and 3) monitors whether access-to-care standards are being met at its clinics and sickbays. GAO analyzed Coast Guard medical staffing and vacancy data as of July 2021, and reviewed relevant staffing and access-to-care policy documents. GAO also interviewed Coast Guard officials responsible for the health services program as well as Coast Guard staff from three clinics selected for variation in geographic location and number of staff.</div>

What GAO Found

The U.S. Coast Guard (Coast Guard) staffs its clinics and sickbays with Coast Guard enlisted personnel and officers, who primarily serve as health service technicians and physician assistants, as well as with U.S. Public Health Service officers, including physicians and dentists. In addition, the Coast Guard uses a contract to fill some of its vacancies and augment other health care staff roles. As of July 2021, Coast Guard data show the service had 1,022 Coast Guard, Public Health Service, and contracted health care staff serving its health services program of clinics and sickbays.

U.S. Coast Guard Health Care Staff by Source, as of July 2021

Note: U.S. Public Health Service Commissioned Corps are public health professionals that serve in federal agencies.

The Coast Guard generally fills positions for its clinics and sickbays based on historical staffing levels. However, the current staffing approach does not address surge deployments of health care staff for missions away from clinics, such as to respond to hurricanes. Deployments have nearly quadrupled from 4,111 days in 2018 to more than 16,000 days in 2021, according to the service’s data. Coast Guard officials expressed concern with difficulties in maintaining already burdened clinic operations when health care staff are deployed, which can result in clinics deferring services. Implementing staffing standards for its health services program that account for surge deployments would help ensure the Coast Guard is best targeting its resources to meet mission needs.

To monitor access to care, the Coast Guard relies on each of its clinics to manually estimate access by counting the number of days to the next available appointment. However, Coast Guard officials stated that this approach does not produce reliable information on whether the Coast Guard is meeting its access-to-care standards. Coast Guard officials said they hope to collect system-wide data on access to care using a new electronic health record system. The Coast Guard expects to complete the system’s initial rollout by September 2022, but officials have not yet determined how to use the system to monitor access. While the service works to better understand the capabilities of the new system, improving its process to collect more reliable access data will allow the Coast Guard to more accurately monitor whether its clinics and sickbays are meeting its access standards.

Why GAO Did This Study

In support of its maritime safety, security, and environmental stewardship missions, the Coast Guard—a military service within the Department of Homeland Security (DHS)—is tasked with providing health care to its approximately 47,000 active duty and reserve personnel. The Coast Guard offers certain outpatient medical and dental services to its personnel through 43 outpatient clinics and 122 sickbays, which are small facilities typically staffed by a health technician.

The William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021 required GAO to review the Coast Guard health care system. This report examines how the Coast Guard 1) staffs its clinics and sickbays, 2) determines its staffing needs, and 3) monitors whether access-to-care standards are being met at its clinics and sickbays.

GAO analyzed Coast Guard medical staffing and vacancy data as of July 2021, and reviewed relevant staffing and access-to-care policy documents. GAO also interviewed Coast Guard officials responsible for the health services program as well as Coast Guard staff from three clinics selected for variation in geographic location and number of staff.

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