Indian healthcare provision then underwent a gradual evolution when eventually on 5 August ; the Transfer Act was passed through Congress. The system implemented by the PHS was highly integrated with regards to services and administration with field stations linked to general hospitals and referral centers. The impact of the IHS was profound with the narrowing of health disparities between Native Americans and the general US population in the decades following its inception.
In , life expectancy was on average nine years lower for Native Americans and infant mortality rates were almost three times higher. Early IHS initiatives focussed on tackling infectious diseases with particular attention to environmental health, sanitation and immunization. The IHS is the principal federal health care provider and health advocate for Indian people, and its goal is to raise their health status to the highest possible level.
The IHS provides a comprehensive health service delivery system for approximately 2. Skip to site content. The law provided the BIA, within the Department of the Interior, explicit authorization for much of the activities that the agency was already undertaking.
It also authorized the employment of physicians to serve Indian tribes. Prior to the Snyder Act, Congress had made detailed annual appropriations for these BIA activities, but funds were not always appropriated because these activities lacked an explicit authorization.
The Snyder Act provided an explicit authorization for nearly any Indian program, including health care, for which Congress enacts appropriations. The Snyder Act did not require any specific programs. This transfer occurred because, among other reasons, Congress felt that the PHS could do a better job of providing health care services to Indians. The act permits tribes to assume some control over the management of their health care services by negotiating "self-determination contracts" with IHS for tribal management of specific IHS programs.
Under a self-determination contract, IHS transfers to tribal control the funds it would have spent for the contracted program so the tribe might operate the program. It also gave IHS authority to grant funding to UIOs to provide health care services to urban Indians and established substance abuse treatment programs, and Indian health professions recruitment programs, among others. The amendment paralleled a change whereby the BIA allowed, under a demonstration, its programs to be compacted.
The demonstration program, involving four tribally operated IHS-owned hospitals and clinics, had increased collections, reduced the turn-around time between billing and receipt of payment, eased tracking of billings and collections, and reduced administrative costs.
The reauthorization expanded IHS activities to include long-term care services, created a continuum of behavioral health and treatment services, and expanded the ability of ITs and TOs to receive reimbursements directly from Medicare and Medicaid. These various committees are described in Table 2 below. In general, legislation amending an existing statute is likely to be referred to the committees that exercised jurisdiction over the original legislation.
As such, the committees that have oversight over these programs have been involved in the IHCIA reauthorization. In addition, these committees have oversight over legislation that affects IHS beneficiary participation in these programs and the ability of IHS-funded facilities to receive reimbursements from these programs. Table 2. IHS Committee Jurisdiction. Committee on Indian Affairs: Holds jurisdiction over all issues related to Indians. Health, Education, Labor, and Pensions: Holds jurisdiction over matters related to public health.
Although IHS services are available free of charge to all eligible beneficiaries, not all eligible individuals choose to receive care at an IHS-funded facility. This may occur because facilities are geographically inconvenient or because needed services are unavailable. IHS focuses on primary and preventive services, so some services may not be available.
Despite this, IHS has attempted to expand services by partnering with local providers, by using technology and paraprofessionals to expand the services that the agency can provide at its facilities, and by preventing disease and encouraging healthy behaviors to reduce the need for expensive health services. There is no uniform definition of the American Indian and Alaska Native population.
Rather, federal agencies use different definitions of this population. Consequently, some individuals who might have previously self-identified as another race, beginning in , were allowed to also identify as American Indian or Alaska Natives. As such, the number of American Indians and Alaska Natives identified increased between the and Censuses beyond what would have been expected due to population growth alone.
The population also increased between and Censuses. Census found that 3. Tribes vary on their definitions of membership; some tribes may reserve membership for those whose parents were both members, while other tribes may trace membership to a grandparent or parent who is a member.
Thus, in some cases, tribal members could be counted by the Census as American Indian or Alaska Native and a member of another race. Conversely, some individuals identifying as multiple races in the Census may not be tribal members.
Despite the limitations of the Census data, IHS uses Census data to estimate its eligible population. BIA data are based on estimates received from BIA agencies and federally recognized tribes, but these estimates are not based on actual censuses and cover only persons on or near reservations. In addition to these limitations, available BIA data are dated because the agency has not published data since Table A Service Population on or near reservations; est.
For and data: Tina Norris, Paula L. Winves, and Elizabeth M. The BIA attempted to survey the tribes in about their service population and labor force estimates, but due to methodological concerns, these data were never released. See Letter from Donald E. The Bureau of Indian Affairs defines "near reservation" as areas or communities either contiguous or adjacent to a reservation that are so designated by the Department's Interior's Assistant Secretary of the Interior for Indians Affairs.
These areas are so designated, in consultation with the relevant Indian Tribe or Alaska Native village governing body, based on criteria such as the number of American Indians or Alaska Natives residing in the area, whether these residents have close affiliation with the Indian Tribe or reservation, the proximity of the area to the reservation, and whether BIA will be able to provide services to this area. Census data are estimates except in decennial Census years and The Census Bureau only began collecting data on American Indians alone or in combination with another race in the Census.
The BIA's report included data for No subsequent report has been released. Determining the urban Indian population eligible for Urban Indian Health Program services is equally inexact. Urban Indian Organizations UIOs serve a wider range of eligible persons, including members of terminated or state-recognized tribes and their children and grandchildren see report section " Urban Indian Health Programs ". They are not, however, authorized to serve anyone who merely identifies themselves as racially American Indian or Alaska Native.
IHS figures for urban Indian populations are based on these Census data. The following timeline see Figure B-1 and Figure B-2 presents a brief overview of federal involvement in Indian health. Federal involvement began as infectious disease control e. Federal involvement in Indian health is rooted in treaties between Indian Tribes and the federal government.
Over time, federal involvement has been formalized in legislation. The timeline below presents some selected events both Indian health specific and some related historical events to provide context. The timeline is followed by a more detailed list of sources. Figure B Sources: See "Timeline Sources" section below. Kappler, Charles J. Indian Affairs: Laws and Treaties , 7 vols. Washington: GPO, [].
Pfefferbaum, Betty, et al. Prucha, Francis Paul. The principal legislation authorizing federal funds for health services to Native American tribes is the Snyder Act of In ratifying the Snyder Act, the federal government intended to provide appropriations "for the benefit, care and assistance. In doing so, Congress noted the past inadequacies of Native American health care, and reaffirmed its intention to involve tribes in health care programs through tribal self-governance.
Subsequent amendments in extended the purpose of the IHCIA to raising the health status of Native Americans over a specified period of time to the level of the general United States population. Additionally, the IHCIA sought a high level of participation by Indian tribes in the planning and management of IHS programs, services, and demonstration projects under subsequent self-determination amendments.
The IHS provides health care services to approximately 1. The IHS health care system consists of health centers, hospitals, and health stations which are managed by service units and eleven Area Offices.
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