Indian H Service Reform

The Policy Problem

Even though the U.S. has an obligation to provide American Indians with free health care on reservations, there is an enormous disparity that exists in both the overall health status and access to health care of AI/ANs.

• Native peoples experience higher disease rates and lower life expectancy than any other racial or ethnic group in the country. Indians experience exponentially higher rates of diabetes, mental disorders, cardiovascular disease, pneumonia, influenza and injuries.
• The infant mortality rate is 150% greater for Indians than that of White infants.
• Indians have the highest prevalence of Type-2 diabetes in the world, and are 2.6 times more likely to be diagnosed with diabetes.
• Indians have a life expectancy 5 years less than the rest of the U.S. population.
• “While campaigning on Indian reservations, presidential candidate Barack Obama cited this statistic: After Haiti, men on the impoverished Pine Ridge and Rosebud Reservations in South Dakota have the lowest life expectancy in the Western Hemisphere.”
• There is an enormous disparity that exists in both the overall health and access to healthcare facilities.

The system is severely underfunded:

• Officials also claim that Congress provides only about 54 cents per dollar they need to provide adequate care.
• “Poorer tribes, often those on the most remote reservations, far away from city hospitals, are stuck with grossly substandard care. The agency itself describes a ‘rationed health care system.’”
• IHS overall has an 18% vacancy rate for doctors, but it is 38% for the region that includes the Dakotas. The region has a 29% percent vacancy rate for dentists; both officials and patients report there is almost no preventive dental care.

Senator Byron Dorgan (D, ND) “believes the problems are systemic within the embattled agency: incompetent staffers are transferred instead of fired; there are few staff to handle complaints; and, in some cases, he says, there is a culture of intimidation within field offices charged with overseeing individual clinics.”

Links

• Jalonick, Mary Clare (AP). Promises, Promises: Indian health care’s victims. Boston Globe. June 15, 2009.
• GAO. Indian Health Service: Millions of Dollars in Property and Equipment Continue to Be Lost or Stolen. GAO-09-450, June 2, 2009. [Summary (HTML)][Highlights Page (PDF)][Full Report (PDF, 47 pages)][Recommendations (HTML)].
• GAO. Indian Health Service: Mismanagement Led to Millions of Dollars in Lost or Stolen Property and Wasteful Spending. GAO-08-1069T, July 31, 2008. [Summary (HTML)][Highlights Page (PDF)][Full Report (PDF, 14 pages)].
• GAO. Indian Health Service: HIV/AIDS Prevention and Treatment Services for American Indians and Alaska Natives. GAO-08-90, December 14, 2007. Summary (HTML)][Highlights Page (PDF)] [Full Report (PDF, 37 pages)]
• “Indian Health Service” and “reform” (Health Affairs search)