15.2 Indian Health Care and the Indian Health Service

Indian health care is a critical issue in Federal Indian Law. The Indian Health Service, established in 1955, provides health services to 2.6 million American Indians and Alaska Natives from 574 federally recognized tribes across 37 states.

Key legislation like the Indian Health Care Improvement Act and Indian Self-Determination Act have expanded tribal control over health programs. However, significant health disparities persist due to factors like historical trauma and limited access to quality care.

Indian Health Service (IHS) and Key Legislation

Establishment and Purpose of the Indian Health Service

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• Indian Health Service (IHS) is a federal agency within the Department of Health and Human Services responsible for providing health care services to American Indians and Alaska Natives
• Established in 1955 to fulfill the federal government's trust responsibility to provide health care to federally recognized tribes
• Operates a comprehensive health service delivery system for approximately 2.6 million American Indians and Alaska Natives who belong to 574 federally recognized tribes in 37 states

Key Legislation Impacting Indian Health Care

• Indian Health Care Improvement Act (IHCIA) enacted in 1976 to address the inadequate and under-funded health care services for American Indians and Alaska Natives
  • Amended and permanently reauthorized in 2010 as part of the Affordable Care Act
  • Modernized and expanded programs and services, including behavioral health treatment and prevention programs (youth suicide prevention)
• Indian Self-Determination and Education Assistance Act (ISDEAA) of 1975 allows tribes to assume control over IHS programs and services
  • Tribes can enter into self-determination contracts or self-governance compacts to manage and operate their own health care programs (638 contracts)
• Affordable Care Act (ACA) provisions for Native Americans include permanent reauthorization of the IHCIA, expanded access to health insurance, and exemption from individual mandate penalty

Health Care Delivery and Services

Health Care Providers and Facilities

• Tribal health programs operated by tribes or tribal organizations under the ISDEAA provide health care services to tribal members
  • Includes hospitals, health centers, clinics, and community health programs (Navajo Nation Department of Health)
• Urban Indian health organizations provide health care services to American Indians and Alaska Natives living in urban areas
  • Funded through grants and contracts from the IHS under Title V of the IHCIA (Seattle Indian Health Board)
• IHS directly operates a network of hospitals, health centers, and clinics in areas where tribes have not assumed control of health care delivery

Purchased/Referred Care and Contract Health Services

• Purchased/Referred Care (PRC), formerly known as Contract Health Services (CHS), is a program that allows IHS and tribal health programs to purchase health care services from private providers when services are not available within the IHS system
  • Eligibility for PRC is based on residency within a contract health service delivery area and membership in a federally recognized tribe
• PRC funds are used to pay for specialty care, emergency care, and other services not available at IHS or tribal facilities (referrals to outside specialists)

Integration of Traditional Healing Practices and Behavioral Health Services

• IHS and tribal health programs incorporate traditional healing practices, such as traditional medicine, ceremonies, and spiritual counseling, into health care delivery
  • Recognizes the importance of cultural beliefs and practices in promoting health and well-being (sweat lodge ceremonies, talking circles)
• Behavioral health services, including mental health and substance abuse treatment, are integrated into primary care settings to address the high rates of behavioral health issues among American Indians and Alaska Natives
  • IHS and tribal health programs offer culturally appropriate prevention, intervention, and treatment services (youth suicide prevention programs, substance abuse treatment)

Health Priorities and Disparities

Health Disparities and Contributing Factors

• American Indians and Alaska Natives experience significant health disparities compared to the general U.S. population
  • Higher rates of chronic diseases, such as diabetes, heart disease, and cancer
  • Higher rates of mental health disorders, substance abuse, and suicide
• Health disparities are influenced by a complex interplay of factors, including historical trauma, socioeconomic conditions, and limited access to quality health care services (poverty, discrimination, rural isolation)

Diabetes Prevention and Treatment Strategies

• Diabetes is a major health concern for American Indians and Alaska Natives, with prevalence rates 2-3 times higher than the general U.S. population
• IHS and tribal health programs implement comprehensive diabetes prevention and treatment strategies
  • Includes patient education, lifestyle interventions, and disease management programs (Special Diabetes Program for Indians)
• Community-based interventions, such as the Diabetes Prevention Program, aim to reduce the incidence of diabetes through healthy lifestyle changes (nutrition education, physical activity promotion)

Maternal and Child Health Initiatives

• American Indian and Alaska Native women and children face unique health challenges, including higher rates of infant mortality, preterm birth, and maternal mortality
• IHS and tribal health programs prioritize maternal and child health through targeted initiatives and services
  • Includes prenatal care, well-child visits, immunizations, and home visiting programs (Nurse-Family Partnership)
• Collaborations with other federal agencies, such as the Maternal and Child Health Bureau, aim to improve health outcomes for American Indian and Alaska Native mothers and children (Healthy Start program)