Hub-and-Spoke Healthcare: Addressing service gaps in rural Alaska.

AuthorOrr, Vanessa
PositionHEALTHCARE

Break your leg in Anchorage and chances are you'll spend a few hours in one of the city's three main hospitals--Alaska Regional Hospital, Providence Medical Center, or the Alaska Native Medical Center. Break it out in the Bush, and you may find yourself having to fly to a larger city to get specialized care, especially if there are complications. While there are many advantages to living in Alaska's remote areas, one of the biggest drawbacks to rural living is the lack of access to specialized healthcare.

"Urban areas by definition are defined as a large population that can support a more robust healthcare infrastructure; rural areas do not have the same advantages," explains Heidi Hedberg, chief of Rural and Community Health Systems, Alaska State Office of Rural Health.

While a number of villages have community health aides, behavioral health aides, and dental health aides, as well as visits from public health nurses, those who require acute or advanced care often find themselves having to leave the community to get the help they need.

"Access to healthcare is an ongoing concern in rural communities, as are workforce shortages and high healthcare costs," says Hedberg. "In general, individuals living in rural communities may receive some healthcare services, but if they need additional services, they would need to travel to a hub community."

Alaska has a hub-and-spoke healthcare system, according to Hedberg, with hub communities typically containing a critical access hospital to serve the surrounding villages. There are fourteen critical access hospitals across the state in Cordova, Ketchikan, Petersburg, Kodiak, Seward, Valdez, Sitka, and Homer, including Alaska Native tribal hospitals in Dillingham, Kotzebue, Sitka, Nome, Utqiagvik, and Wrangell.

Approximately 150,000 Alaska Natives use the Alaska Tribal Health System, which operates 180 small community primary care centers, more than two dozen mid-level care centers, six regional hospitals, and the Alaska Native Medical Center in Anchorage.

If patients need more advanced care than a primary or regional care center or hub hospital can offer, they may travel to Alaska's larger cities. Some people living in Southeast communities also choose to travel to Washington State for healthcare services because it is closer than many Alaska facilities.

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