Overview of Health Care Systems for AI/AN

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Overview of Health Care Systems for AI/AN
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I/T/U

• Indian Health Service
• traditional IHS hospitals and clinics
• Tribes
• tribally-operated hospitals and clinics
• contracting/compacting
• Urban facilities
• urban Indian health programs

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Facilities Operated byIHS Tribes
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The Indian Health Service

• Joined the Department of Health and Human
  Services in 1955
• Federal health care provider for members of
  federally-recognized tribes
• Discretionary budget
• Most IHS facilities located on reservations in
  rural area
• Chronically under-funded

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IHS User Population by Area, 2008 Total 1,483,423
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Tribal Health Programsin Region VIII

• Aberdeen Area (0)
• Billings Area (2)
• Chippewa Cree Tribe of the Rocky Boys
  Reservation (since 1995)
• Confederated Salish Kootenai Tribes of the
  Flathead Nation (since 1993)
• Phoenix Area (0 in UT)

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Urban Indian Health

• gt60 of AI/AN live in urban areas
• IHS contracts with 34 non-profit organizations to
  provide care to urban AI/AN
• Services are on sliding fee scale
• Scope of care is often limited
• Many are FQHCs and serve the broader community
• UIHP funding level estimated at 22 of projected
  need for primary care services
• 18 additional cities identified as needing an UIHP

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UIHPs in Region VIII

• Colorado
• Denver Indian Health and Family Services - Denver
  
• Montana
• Indian Health Board of Billings, Inc. Billings
• North American Indian Alliance Butte
• Indian Family Health Clinic - Great Falls
• Helena Indian Alliance Helena
• Missoula Indian Center Missoula
• South Dakota
• South Dakota Urban Indian Health, Inc. Pierre
• Utah
• Indian Walk-In Center - Salt Lake City

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Indian Health Boards

• Advocate on behalf of tribes in each Area
• Help develop health policy, planning, and program
  design
• Gather information and review public opinion and
  proposals
• Serve as the communication link between Tribes
  and the National IHB (NIHB)
• House the Tribal Epi Centers

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Tribal Epi Centers

• 12 TECS
• Core funding from IHS, able to compete for other
  funds
• Purpose is to build epi capacity at local level
  and more directly respond to the epi needs of the
  tribes

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State-Tribe Relations

• Relocation of AI/AN off reservations changed
  relationship between AI/AN and states
• Historically limited interaction between tribes
  and state governments
• With relocation, issues of jurisdiction and
  responsibility for services delivery arose
• Tribes relationship with federal government does
  not nullify the relationship between AI/AN and
  the state where they reside

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• AI/AN are citizens of their tribal nations,
• the states in which their tribes
• are located, and the US
• and have all the rights and
• responsibilities of each

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Mutual Interests BetweenStates and Tribes

• Protecting health and welfare of their people
• Effectively and efficiently using public
  resources
• Providing comprehensive programs and services
• Protecting the natural environment
• Engaging in economic development opportunities

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Examples of Tribal-State Collaborations?
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Tribal-State Collaboration

• Resources (funding, staffing, technical
  assistance)
• Tribal Liaisons
• Offices of Native American Affairs
• Tribal Consultation
• Workgroups and Committees
• Public Health Efforts (screening, reporting,
  outbreak investigation)
• Joint Ventures
• Cross deputization