Indian Health ServicesTribal Nationsand theDelivery of Healthcare566 Federally-recognized Tribes in 36 StatesSovereign NationsDistinct culture, language and traditionsLive on trust land...

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Many Native American tribes are opting to run their own health care services rather than allowing Indian Health Services (IHS) to do it for them. Why do you think tribes are making this choice?








Indian Health Services Tribal Nations and the Delivery of Healthcare 566 Federally-recognized Tribes in 36 States Sovereign Nations Distinct culture, language and traditions Live on trust land and in urban areas Economic Diversity Tribal Membership * AI/AN alone3.2 million AI/AN in combination with one or more other races 2.0 million Total AI/AN 5.2 million Reported a specific tribal affiliation 74% IHS Service Population 2 million Mission: To raise the physical, mental, social, and spiritual health of American Indians and Alaska natives to the highest level Goal: To assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people Foundation: To uphold the Federal Government’s obligation to promote healthy American Indian and Alaska Native people, communities, and cultures and to honor and protect the inherent sovereign rights of Tribes Indian Health Service Pre-Contact/Tradition Medicine Impact of European Settlement Constitution/Treaties/Legislation Supreme Court Sovereignty Federal Trust Responsibility Government to Government Relationship * 1800’s – Responsibility of the War Department Indian Removal Indian Removal Act of 1830 1836 – Medical services for land cessions 1849 - BIA/Department of Interior Dawes Act – General Allotment Act 1887 Reservation land divided into allotments Ban on traditional practices Introduction of boarding schools * Treaty/trust responsibility Reservation health care is a federal responsibility. Federal policy of tribal self-determination Began in the mid-1970s for a number of services previously managed by the federal government. Since the 1980s, a growing number of Native nations have taken over management of various aspects of health-care delivery Under the US Department of Health and Human Services Comprehensive, primary health care system and some public health services Only federal agency to provide direct medical care Trust Responsibility: Members of federally recognized tribes * IHS serves 2m people from 566 tribes 12 area offices and 163 IHS and tribally managed service units Tribally-operated health care services Tribal facilities are operated under the authority of the Indian Self-Determination and Education Assistance Act (Public Law 93-638, as amended) A Quick Look at the Size of IHS FY 2012 spend authority is approximately $5.0 billion. Indian Health Service total staff consists of about 15,700 employees, which includes approximately 2,400 nurses, 800 physicians, 400 engineers, 500 pharmacists, 300 dentists, and 300 sanitarians. * * Broken into three types of health programs: Indian Health Service – Federally operated Facilities Tribally Operated Facilities – Established under PL 93-638, Indian Self-Determination Act Urban Health Programs – Established under the Indian Health Care Improvement Act * 82 Title V compacts (337 tribes; nearly 60% of tribes) 231 Title I contracts 33 Urban Indian health care services and resource centers, ranging from community health to comprehensive primary care services Approximately 600,000 American Indians and Alaska Natives reside in counties served by urban Indian health programs. Direct Healthcare Services: Onsite services provided at an I/T/U Contract Health Services: Services delivered by a non-I/T/U facility or provider through contracts. Special money allocated by Congress to use specifically for patient care not covered by other programs. CHS are provided principally for members of federally recognized tribes who reside on or near the reservation established for the local tribe(s) in geographic areas called contract health service delivery areas (CHSDAs) . The eligibility requirements are stricter for CHS care than for direct services. No IHS direct-care facility exists The direct care facility is incapable of providing the required emergency and/or specialty care. The direct care facility has an overflow of medical care workload To supplement alternate resources. Those members of federally recognized tribes as determined by the local I/T/U. Non-Indian woman pregnant with an eligible Indian’s child—during pregnancy and 6 weeks post partum. Must reside on the reservation/territory located within the CHSDA. (Exemptions include full-time students, children in foster care, close social and economic ties, and 180 day coverage for those members who have moved away.) Services must fall within the established medical priorities. Must exhaust alternate resources* because federal law requires that IHS is payor of last resort. *Alternate Resources include: Medicaid, Medicare, Private Insurance, Other 3rd party resources. In “emergency cases” the patient must notify the respective CHS office within 72 hours after the beginning the treatment or after admission to a non-I/T/U facility. Services or supplies furnished by any other program/s Nursing home care Abortions Procedures that are strictly Cosmetic Burials and related expenses Housekeeper and companion services *This is not an exhaustive list The Indian Self-Determination and Educational Assistance Act 1975 P.L. 93-638 Tribes can manage their health programs Title I: CONTRACT part or all of the services Title V: COMPACT entire health programs Funding issues: shares, contract support costs * Why are some Native nations shifting from IHS provision to tribal management of health care? How is the shift to tribal management changing health-care delivery? What new challenges (if any) are emerging? What solutions (if any) are tribes developing? Does tribal management lead to better health-care delivery than direct HIS Management? Six comparison studies, published 1996-2002, analyzed data from 1980s-2001 Four studies said tribal management leads to improved quality, expanded coverage, and easier access to health care services. All six studies identified considerations for tribes to contemplate when moving toward tribal management or while managing health care services. Five categories: funding, institutional, treaty and trust responsibilities, information needs, and access to health care services. Tribal responsibility for community health Change from federal action to indigenous action, while holding the federal government to their treaty commitments Tribal engagement in the delivery of health care Tribal health and other department program, 638 tribes have some type of contracting of health services, compacting of health services, etc. National Factors Shortcoming in the IHS system Local circumstances, such as small communities and remote location that complicate access to services Tribal Factors The drive for self-governance and local control What other tribes are doing and have experienced, especially those that are geographically close For some, the conflict between federal responsibility and tribal role in health care delivery Search for additional funding sources and pool available funds Partner with other tribes, non-tribal governments, educational institutions, etc. Increase tracking of results Re-conceive the “service area: Change locally available services and add a broader range of services Accountable to tribal citizens Complexity of health-care systems means that managing such systems requires skilled, professional management and good customer service. Strong health programs depend in part on stability and professionalism in tribal government—and keeping tribal politics under control. Funding remains a major challenge. Funding stipulations can define who can receive services, and require collection and reporting of data that may not be meaningful or useful to the tribe. While numerous tribes are addressing healthcare management issues, it is not easy for them to learn from each other through sharing stories. Emergent/Acutely Urgent Care – Services necessary to prevent the immediate death or serious impairment of the health of an individual. Preventive Care Service – Primary health care aimed at the prevention of disease or disability. When a person needs something to keep them from moving to level Primary Secondary Care Services – Inpatient and outpatient care services care services that have a significant impact on morbidity and mortality. Chronic Tertiary and Extended Care Services – in-patient and outpatient care services that are not essential for (1) initial/emergent diagnosis or therapy, (2) have less impact on mortality than morbidity, or (3) are high cost, elective, and often require tertiary care facilities. * * 1.pdf January 2006 2005 IHS Expenditures Per Capita Compared to Other Federal Health Expenditure Benchmarks $5 ,6 70 $4 ,6 53 $4 ,3 28 $3 ,2 42 $2 ,9 80 $847 $753 $581 $682 $743 $923 $- $ 6, 78 4 $2 ,1 30 $- $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 Medicare National Health Expenditures Veterans Administration Medicaid Medical for Federal Prisons FEHB Medical Benchmark 2005 IHS Expenditures IHS 2003 19992002 1999 Growth Forecast Through 2005 2002 Last Actual Data $498 IHS Medical Non- medical See notes on reverse for data sources and forecast assumptions. 2002 January 2006 Data Sources for Health Care Expenditures Per Capita Chart 1. MEDICARE EXPENDITURES PER ENROLLEE: Source – Centers for Medicare and Medicaid Services website, 2/6/2006 [http://www.cms.hhs.gov/MedicareMedicaidStatSupp/05_2004%20Edition.asp#TopOfPage]. Table 16 reports $6,784 as the average Medicare payment per beneficiary in 2002 (the last year of published data). The historical average growth rate has varied. The 2002 per beneficiary payment is extrapolated to $7,631 in 2005 assuming payments grew at an annual rate of 4%. 2. MEDICAL CARE FOR VETERANS ADMINISTRATION USERS: Source – Veteran's Administration website, 2/6/2006 [http://www.va.gov/vetdata/ProgramStatics/stat_app02/Table%2011%20(02).xls]. Table 1 reports $4,653 as the national average health cost per user in 2002 (the last year of published data). The historical average growth rate has varied. The 2002 per beneficiary payment is extrapolated to $5,234 in 2005 assuming costs grew at an annual rate of 4%. 3. NATIONAL HEALTH CARE EXPENDITURES PER CAPITA : Source – Centers for Medicare and Medicaid Services website, 2/6/2006 [http://www.cms.hhs.gov/NationalHealthExpendData/downloads/nheprojections2004-2014.pdf]. Table 1 reports $5,670 as the national average health care expenditure per person in 2003 (the last year of published data). CMS also projects future expenditures considering various economic factors. CMS projects $6,423 in 2005. 4. MEDICAID PAYMENTS PER BENEFICIARY: Source – Centers for Medicare and Medicaid Services website, 2/6/2006 [http://www.cms.hhs.gov/MedicareMedicaidStatSupp/05_2004%20Edition.asp#TopOfPage]. Table 111 reports $4,328 as the average Medicaid payment per person in 2002 (the last year of published data). The historical average growth rate has varied. The 2002 per beneficiary payment is extrapolated to $5,010 in 2005 assuming payments grew at an annual rate of 5%. 5. MEDICAL CARE FOR FEDERAL PRISON INMATES: Source – General Accounting Office, Report and Testimony GAO/T-GGD-00-112, Federal Prisons- Containing Health Care Costs for an Increasing Inmate Population, April 2000. According to GAO, the medical care expenditures for federal prison inmates was $3,242 per capita in 1999. Data for subsequent years is unavailable. Assuming a conservative growth of 3.5% annually (< ½ the medical inflation average), the amount is extrapolated to $3,986 in 2005. 6. fehb medical care benchmark per ihs user: source -- indian health service, level of need funded report (later renamed the federal disparity index report) by the lnf workgroup, 1999 – ihs website. the lnf study used insurance premiums for the federal employee health benefits program as a benchmark for actuarial projections for costs of equivalent benefits to ihs users. the study found an initial benchmark cost of $2,980 for equivalent fehb benefits when characteristics and cost risks of indian people were considered. the annual rate of increase the bls medical cpi was applied to the 1999 benchmark to forecast $3,903 for 2005. 7. ihs expenditures per user: source -- the indian health service budget and appropriations tables for 2005. expenditures from appropriations plus collections are divided by the 2005 ihs user population to compute actual expenditures per user. the breakout for “medical care” and “non-medical” ihs programs is based on a detailed line-item analysis in 2001. these data are current and no forecast to 2005 are necessary. * 2.pdf trends in revenue, costs, users, & buying power per patient $- $1,000 $2,000 $3,000 $4,000 m ill io ns $ n c m n $470 $473 $474 $495 $515 $543 $575 $652 $664 $678 $706 $716 c $176 $192 $256 $293 $352 $391 $428 $558 $579 $579 $710 $750 m $1,467 $1,487 $1,512 $1,564 $1,593 $1,705 $1,824 $2,062 $2,121 $2,198 $2,254 $2,309 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 $3,774 $2,113 $2,640 appropriations -- non-medical collections -- medical appropriations -- medical 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 annual cumulative ihs revenues grew by 75% . . . while inflation grew by 56% . . . and # of users grew by 14% . . . which resulted in flat buying power per individual patient. buying power per capita is expressed in 2003 nominal dollars 1,000,000 1,050,000 1,100,000 1,150,000 1,200,000 1,250,000 1,300,000 1,350,000 1,400,000 1,450,000 1,500,000 users 1,256,532 1,284,960 1,300,634 1,322,471 1,344,308 1,366,145 1,387,982 1,364,560 1,383,664 1,411,224 1,435,763 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 $- $1,000 $2,000 $3,000 $4,000 $5,000 p er c ap it a b uy in g po w er in 2 00 3 $ us $4,356 $4,394 $4,453 $4,501 $4,547 $4,612 $4,739 $4,883 $4,985 $5,075 $5,063 ihs total $2,308 $2,271 $2,289 $2,283 $2,328 $2,357 ½="" the="" medical="" inflation="" average),="" the="" amount="" is="" extrapolated="" to="" $3,986="" in="" 2005.="" 6.="" fehb="" medical="" care="" benchmark="" per="" ihs="" user:="" source="" --="" indian="" health="" service,="" level="" of="" need="" funded="" report="" (later="" renamed="" the="" federal="" disparity="" index="" report)="" by="" the="" lnf="" workgroup,="" 1999="" –="" ihs="" website.="" the="" lnf="" study="" used="" insurance="" premiums="" for="" the="" federal="" employee="" health="" benefits="" program="" as="" a="" benchmark="" for="" actuarial="" projections="" for="" costs="" of="" equivalent="" benefits="" to="" ihs="" users.="" the="" study="" found="" an="" initial="" benchmark="" cost="" of="" $2,980="" for="" equivalent="" fehb="" benefits="" when="" characteristics="" and="" cost="" risks="" of="" indian="" people="" were="" considered.="" the="" annual="" rate="" of="" increase="" the="" bls="" medical="" cpi="" was="" applied="" to="" the="" 1999="" benchmark="" to="" forecast="" $3,903="" for="" 2005.="" 7.="" ihs="" expenditures="" per="" user:="" source="" --="" the="" indian="" health="" service="" budget="" and="" appropriations="" tables="" for="" 2005.="" expenditures="" from="" appropriations="" plus="" collections="" are="" divided="" by="" the="" 2005="" ihs="" user="" population="" to="" compute="" actual="" expenditures="" per="" user.="" the="" breakout="" for="" “medical="" care”="" and="" “non-medical”="" ihs="" programs="" is="" based="" on="" a="" detailed="" line-item="" analysis="" in="" 2001.="" these="" data="" are="" current="" and="" no="" forecast="" to="" 2005="" are="" necessary.="" *="" 2.pdf="" trends="" in="" revenue,="" costs,="" users,="" &="" buying="" power="" per="" patient="" $-="" $1,000="" $2,000="" $3,000="" $4,000="" m="" ill="" io="" ns="" $="" n="" c="" m="" n="" $470="" $473="" $474="" $495="" $515="" $543="" $575="" $652="" $664="" $678="" $706="" $716="" c="" $176="" $192="" $256="" $293="" $352="" $391="" $428="" $558="" $579="" $579="" $710="" $750="" m="" $1,467="" $1,487="" $1,512="" $1,564="" $1,593="" $1,705="" $1,824="" $2,062="" $2,121="" $2,198="" $2,254="" $2,309="" 1994="" 1995="" 1996="" 1997="" 1998="" 1999="" 2000="" 2001="" 2002="" 2003="" 2004="" 2005="" $3,774="" $2,113="" $2,640="" appropriations="" --="" non-medical="" collections="" --="" medical="" appropriations="" --="" medical="" 0.0%="" 10.0%="" 20.0%="" 30.0%="" 40.0%="" 50.0%="" 60.0%="" 70.0%="" 1994="" 1995="" 1996="" 1997="" 1998="" 1999="" 2000="" 2001="" 2002="" 2003="" 2004="" 2005="" annual="" cumulative="" ihs="" revenues="" grew="" by="" 75%="" .="" .="" .="" while="" inflation="" grew="" by="" 56%="" .="" .="" .="" and="" #="" of="" users="" grew="" by="" 14%="" .="" .="" .="" which="" resulted="" in="" flat="" buying="" power="" per="" individual="" patient.="" buying="" power="" per="" capita="" is="" expressed="" in="" 2003="" nominal="" dollars="" 1,000,000="" 1,050,000="" 1,100,000="" 1,150,000="" 1,200,000="" 1,250,000="" 1,300,000="" 1,350,000="" 1,400,000="" 1,450,000="" 1,500,000="" users="" 1,256,532="" 1,284,960="" 1,300,634="" 1,322,471="" 1,344,308="" 1,366,145="" 1,387,982="" 1,364,560="" 1,383,664="" 1,411,224="" 1,435,763="" 1995="" 1996="" 1997="" 1998="" 1999="" 2000="" 2001="" 2002="" 2003="" 2004="" 2005="" $-="" $1,000="" $2,000="" $3,000="" $4,000="" $5,000="" p="" er="" c="" ap="" it="" a="" b="" uy="" in="" g="" po="" w="" er="" in="" 2="" 00="" 3="" $="" us="" $4,356="" $4,394="" $4,453="" $4,501="" $4,547="" $4,612="" $4,739="" $4,883="" $4,985="" $5,075="" $5,063="" ihs="" total="" $2,308="" $2,271="" $2,289="" $2,283="" $2,328="">
Answered 2 days AfterJan 23, 2023

Answer To: Indian Health ServicesTribal Nationsand theDelivery of Healthcare566 Federally-recognized...

Dr Insiyah R. answered on Jan 25 2023
37 Votes
Title: Indian health service (IHS)

Introduction    1
Conclusion    2
References    3
Introduction
Located inside the Department of Human Services, the Indian Health Service (IHS) is a medical in
itiative (Bruce et al,2021). At IHS facilities, it offers qualified American Indians and Alaska Natives government health services (Fonda et al,2020). IHS offers medical, dental, and eye care and auxiliary services like laboratory, pharmacy, and speciality care, including services rendered by doctors or other specialists (Kaufman et al,2022). The type of healthcare is influenced by the requirements of the community, available resources, and if the therapy is medically essential. When THE INDIAN HEALTH SERVICE (IHS) was founded in 1955, it was up against an enormous challenge.
Poor rural Indian inhabitants suffered greatly from illness. Infant mortality increased to four times the national norm as tuberculosis persisted in its resurgence. The IHS has significantly improved health conditions over the past 50 years, although gaps exist. The health conditions of American Indians are still among the poorest in the country.
The differences have lasted for 500 years rather than 50, which is more astonishing than their longevity (Bruce et al,2021).
American Indians have endured more hardships from the beginning of colonisation, regardless of whether smallpox, tuberculosis, alcoholism, or other chronic ailments of contemporary society were in vogue.
Since access to quality medical care is a fundamental human right, everyone should have it. This is not always the case in the United States, though, since some communities, including those of Native Americans, do not have access to the same level of medical treatment as other populations. As a result, it is the duty of the Indian Health Service (IHS), a division of the U.S. (Fonda et al,2020). Department of Health and Human Services, to provide for the medical requirements...
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