In the previous post of this series, we briefly described the history of the Indian Health Service (IHS) and the legislative foundations of its authority. This post explores the IHS’s authority for healthcare delivery and is an overview of its provision of healthcare to American Indian and Alaskan Natives (AI/AN).
According to their data, the IHS provides healthcare services in 37 states that encompass 574 federally recognized tribes. It also provides funding for the care of approximately 2.6 million AI/AN individuals (1). IHS maintains 118 health facilities, including 28 hospitals and 90 outpatient facilities. In addition, there are 534 Tribally operated facilities, including 18 hospitals and 516 outpatient facilities.
While it is sometimes confused for an insurance program, the IHS actually delivers care – mostly outpatient primary care to eligible members primarily in rural settings. It also funds the health programs for AI/AN that are operated by Tribes as well as urban and recruitment programs (2). However, underfunding of the IHS generally limits the provision of comprehensive healthcare services, such as specialty care, as promised through federal Trust Responsibility (Read IHS Blog Series Part 1).
The IHS generally offers limited inpatient, outpatient, dental, ambulatory, emergency, and public health services. It operates a number of Critical Access Hospitals, which are small, rural hospitals that provide crucial services in rural areas (3). Services from an IHS facility to eligible beneficiaries are free of charge. A referral for specialized care often requires the patient to self-fund if they do not have insurance, although there are limit contracted services and providers available through a purchased/referred care (PRC) contract with the IHS. A catastrophic health emergency fund (CHEF) may also reimburse for cases that are very high cost such as extensive trauma. CHEF is also underfunded and therefore, is not able to cover the cost of the total number of cases that qualify (2).
Eligibility for IHS care extends to members of a federally recognized AI/AN Tribe who are active in a Tribal community. Eligibility also includes certain non-Indian individuals, including the non-Indian spouses and children of an eligible Tribal members as well as limited services to IHS employees, for example (4). More information about eligibility can be found here.
IHS has several specialized national programs focused on specific health issues common in AI/AN communities. Behavioral healthcare is an essential aspect of the care offered by the IHS to address the conditions that result from behavioral related issues such as violence, suicide, substance use, and mental health disorders. Due to historical trauma and perpetuated social disparities, the prevalence of these issues tends to remain higher in AI/AN communities. Appropriately, such programs have been increasingly taken over by Tribal management with integrated cultural knowledge specific to that Tribe (5).
In recognition of the high prevalence of type 2 diabetes among AI/AN communities, the IHS has a Division of Diabetes Treatment and Prevention (DDTP) that specifically focuses on treatment and prevention of diabetes and associated complications (6). The IHS also operates a program that focuses on infectious diseases common among AI/AN communities (2).
Many argue the IHS’s scope of service does not adequately meet the needs of the AI/AN population. Specific issues surrounding this will be explored in following posts.