Coast Guard Health Care: Improvements Needed for Determining Staffing Needs and Monitoring Access to Care
Fast Facts
The Coast Guard provides health care to its personnel through outpatient clinics. It had 1,022 health care staff in 2021. Is that enough?
We found that the Coast Guard can't be sure. It doesn't have standards to outline the number and types of health care staff it needs. For example, other health care organizations use benchmarks such as the ratio of patients per doctor or nurse.
In addition, the Coast Guard doesn't have reliable information on whether its personnel are receiving health care in a timely manner.
Our recommendations are to address these issues.
Highlights
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.
Recommendations
GAO is recommending the Coast Guard implement (1) staffing standards for its health services program, and (2) a process for collecting more reliable data to monitor access to care at clinics and sickbays. We provided a draft of this report to DHS for review and comment. DHS concurred with our recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| United States Coast Guard | The Commandant of the Coast Guard should ensure the Assistant Commandant for Human Resources implements health care staffing standards for its health services program that account for health care staff deployments, including surge deployments. (Recommendation 1) |
In January 2023, the Coast Guard stated that, as required by Section 8260(c) of the of the Elijah E. Cummings Coast Guard Authorization Act of 2020 (P.L. 116-283), it is drafting a report to Congress that provides recommendations for medical staffing standards based on findings from our 2022 report. The Coast Guard estimated completion for this report to Congress in August 2023. In May 2023, the Coast Guard signed a manpower requirements model that the agency said it will use to develop a medical staffing model. According to the Coast Guard, the agency will develop the staffing model based on program needs identified as part of a healthcare system review and strategic plan, as required by Section 11407 of the Don Young Coast Guard Authorization Act of 2022 by September 2024. We will continue to monitor the Coast Guard's efforts in implementing this recommendation.
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| United States Coast Guard | The Commandant of the Coast Guard should ensure the Assistant Commandant for Human Resources improves its process to collect more reliable data on access-to-care at clinics and sickbays to monitor whether access-to-care standards are being met while the service works with the Defense Health Agency to better understand the capabilities of the new electronic health record system for monitoring access-to-care. (Recommendation 2) |
In January 2023, the Coast Guard said it was considering recommendations from additional GAO work on Coast Guard access to health care, which will be published in March 2023. In June 2023, the Coast Guard published an Access to Care policy to outline processes to monitor data and improve access to care. The policy includes documenting Coast Guard roles and responsibilities, processes for making and monitoring appointments, and processes for monitoring access to care measures for appointments in all settings. The policy also addresses collaboration with the Defense Health Agency to monitor data on access to care collected through the electronic health record system. By taking these steps, the Coast Guard will be better able to monitor whether its staff are accessing health care within its access standards, and therefore we consider this recommendation to be implemented.
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