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The Rationing of Healthcare and Health Disparity for the American Indians/Alaska Natives
Pages 528-551

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From page 528...
... The History of Health Disparities Among American Indians/Alaska Natives Health disparity has long haunted the lives of American Indians and Alaska Natives, beginning with the European contact and continuing over the next four centuries as tribe after tribe was either completely decimated or severely depopulated by waves of communicable diseases and by warfare. Although the types and severity of these health disparities have changed over time, some diseases continued to have an impact on the surviving tribes after they were removed and resettled on federal reservations.
From page 529...
... Evidence-based documentation on the extent or types of health disparities for all 500+ tribes and villages nationwide remains elusive, as is information on the quality of healthcare provided to this population. General information, however, is available about some factors that contribute to health disparities for American Indians and Alaska Natives, and this information includes a number of geographic, cultural, education, and financial barriers to adequate healthcare.
From page 530...
... In 2000, Dr. Michael Trujillo, the director of the IHS, attributed health disparities for American Indians/Alaska Natives to a number of underlying causes, including social and cultural disruption of tribal societies, poor education, longstanding poverty, lack of political presence, limited access to health services, and a widening gap in healthcare spending (Trujillo, 2000~.
From page 531...
... The mobilization helped build a political voice in the Indian health arena, including fostering a number of national organizations that focused primarily on health, such as the National Indian Health Board. The chair of this national organization, Sally Smith, an Alaska Native, recently reminded members of the Senate Indian Affairs Committee that: For American Indian and Alaska Native people, the federal responsibility to provide health services represents a "pre-paid" entitlement, paidfor by the cession of over 400 million acres of land to the United States.
From page 532...
... The general definition of who is eligible includes a number of criteria, not least of which is the requirement that the individual be of Indian descent, be regarded as a tribal member by his or her tribe, has some legal evidence of tribal enrollment or a Certificate of Indian Blood, resides on or near his or her federal reservation, and/or meets other local requirements (OTA, 1986~. Generally, those who meet these eligibility requirements are not subjected to an economic means test in order to receive service, although most American Indians/Alaska Natives served by the federal IHS or tribal health programs are three times more likely to live in poverty than other Americans (The Henry I
From page 533...
... Following the Snyder Act, the next major legislative milestone aimed at addressing health disparities for American Indians and Alaska Natives was vested in the passage of the Indian Health Improvement Act in 1976 (reauthorized and amended since its passage)
From page 534...
... At the present time, the tribes manage 13 hospitals, 158 outpatient health centers, 158 village clinics in Alaska, 76 health stations, and five school health programs (http://info.ihs.gov)
From page 535...
... One Indian physician noted "that unless there is continuing congressional and political support, the realization of self-determination by tribes may make it easy for the federal government to terminate its federal responsibility" (Bergman et al., 1999:601~. Whether they live in urban or rural communities, healthcare services for American Indians and Alaska Natives eligible for Medicare or Medicaid are another new problem for IHS and for other health programs intended to serve Indians.
From page 536...
... The underutilization of Medicaid by American Indians and Alaska Natives has been documented elsewhere. For example, although not all states collect or report Medicaid participants by race, statistics from a 1995 report by the Health Care Financing Administration (HCFA)
From page 537...
... The Tribal/Consumer Perspective Although cautious and concerned about both the possible impacts of MCOs and the threats to self-governance, most tribal health leaders, American Indian/Alaska Native health professionals, and the leadership of the urban and village-based health programs are not pessimistic. A study reported by the National Indian Health Board in 1999 found that a majority of the 210 tribes and health organizations they surveyed support local control of health services and self-determination.
From page 538...
... The Albuquerque group directed much of its dissatisfaction and concern over cultural insensitivity and discriminatory behavior at healthcare providers from the private sector rather than at IHS or tribal providers. When discussing the lack of understanding of traditional tribal healing by providers outside IHS and/or tribal health programs, one participant added that she would like these providers to also "understand how traditional medicine can lead to healing [for]
From page 539...
... The Interviews In the present study, we sought to qualitatively assess current thinking from a cross-section of tribal health leaders, consumers, healthcare providers, and urban healthcare administrators on such topics as health disparities, quality of healthcare, healthcare financing, local management of healthcare, and issues of discrimination. To accomplish this, we conducted approximately 22 telephone interviews (including one telephone conference call with 7 providers)
From page 540...
... is able to negotiate or set rates for medical services they purchase for the poor or the elderly (lY 6/22/011. As noted above, providers generally reported that their tribally managed, community controlled, or IHS health facilities provided quality care, despite limited funding.
From page 541...
... One IHS health program administrator noted: "We are rationing healthcare, and depending on what medical services are needed, some individuals might not be able to receive the type of care needed directly in our facilities" (JY 8/31/01~. Another provider stated that unlike other large federal health programs, healthcare rationing is necessary because the federal Indian health appropriation is not based on need.
From page 542...
... Access to CHS even during times of emergencies is not without problems for the patients. For example, Indian patients who utilize a non-tribal or a non-IHS facility during a medical emergency have only 48 hours to notify their respective IHS facility and/or appropriate tribal health administrator to be considered for coverage under the CHS program.
From page 543...
... While some of the problems delineated in the previous section remain endemic, some interviewees saw quality healthcare improvement as tribes have assumed local control of health programs by contracting or compacting. For example, one IHS provider noted: My sense is that on balance, contracting and compacting has improved healthcare services.
From page 544...
... A director of one of the tribal health programs also reported positive trends under compacting. She noted that they have been able to build two new clinics and to increase the range of services offered by the tribal communities.
From page 545...
... For example, one tribal leader said it was her experience that when she and other tribal leaders lobby for increasing healthcare dollars for Indian health, some legislators fear that if they support these efforts, their other constituents will think that Indians are getting something for nothing or that Indians will have a special advantage over other Americans. An urban health program director said that discrimination was a major problem in his state but is not being addressed, even by state leaders.
From page 546...
... One of the staff members on the conference call went on to indicate that the ability to pay or the possession of a bonafide authorization does not always translate into quality care for Indian patients. Another tribal health program staff member elaborated: Even [our]
From page 547...
... Some of those interviewed also described ways they have attempted to address discrimination. One IHS director of a consortium of tribal health programs in the eastern United States reported that they constantly try to educate agencies or entities that deny services to Indian patients to teach them that as citizens of their respective states, Indians are eligible for state, county, or local health resources.
From page 548...
... What Is Being Done to Address Health Disparity? The bottom line about health services for American Indians/Alaska Natives, according to one provider, is that most of the health programs do not have adequate funding or resources to reduce health disparities.
From page 549...
... Lack of adequate funding ripples into all aspects of the healthcare delivery systems, which has affected the ability of the Indian health programs to recruit and hire staff, to commit to long-range health planning, to target resources for prevention and research, and to ensure culturally appropriate healthcare. Tribal and urban-based Indian health programs have developed strategies to off-set the ever growing financial hardships, but they, along with IHS, are now facing other new challenges, such as managed care.
From page 550...
... (1994~. Health Status of Urban American Indians and Alaska Natives.
From page 551...
... Kaiser Family Foundation Policy Brief. Washington, DC: The Henry J


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