NATIVE AMERICAN
HEALTH DELIVERY SYSTEM
UNDER MEDICAID REFORM
Native Americans are currently treated as second class citizens and this is evident in the type of health care they receive. Although the federal government provides limited funding to Indian Health Service (IHS), it is not enough in order to provide the appropriate type of health care to this population. It is important to note that IHS is a residual payer. This means that other payment sources for which an Indian patient is eligible (i.e. Medicaid) must be exhausted before IHS will pay for services. In addition, Indians are being stripped of their own forms of independent funding, such as their casino revenues, because the federal government prohibits gambling on reservations.
There are many problems with IHS, such as accessibility and funding, that cannot be rectified without efforts from state and federal governments. Moreover, Medicaid reform has added to the problems, instead of improving the Native American health care delivery system. Although Indians compose a small percentage of the Medicaid population, it could be reduced if Indian Health Care Service (IHCS) providers were included in the networks of Managed Care Organizations. If a successful health care system for Indians is created, then there is an excellent possibility of utilizing their program for dealing with the nation’s Medicaid population and treatment of both illegal and legal immigrants. Moreover, this will improve the availability and accessibility to quality, cost-efficient health care, which these neglected individuals deserve.
Provides background on Indian Health Service and
the Native American health care system. Also, discusses problems and current
projects to improve the poor conditions of Indian health care (i.e. Design
for a New IHS). Links, such as About the Indian Health Service, Year
2000 Project, Management Resources, and Public Information,
provides information on the comprehensive program, the budget for year
2000, and discusses the Indian health manual and eligibility requirements
for IHS. It is an informative site that discusses current health issues
as well in terms of Native American health care.
Nebraska Urban Indian Medical Center (NUIMC)
NUIMC gives a background on themselves and the
services they offer. They accepts clients, regardless of their ability
to pay, with a sliding fee scale. It is an interesting site to look at
because it provides a possible model for other Indian health care clinics.
Moreover, it offers access to related sites which involve in depth descriptions
of preventive programs and culturally sensitive, medical services.
United States Department of Health and Human Services
This search site is especially valuable because
it gives one the opportunity to submit specific searches related to Native
American health care. For example, when "urban Indians" was typed in, it
revealed several documents and sites which discuss the health challenges
of Native Americans and the recent restructuring programs of IHS. It looks
at both Indians who occupy the reservations and those who live in urban
areas. It is an excellent search engine for this topic. It also provides
statistical information upon request.
Native Health Research Database
The NHRD:
This site provides access to specific searches
about statistics
and Indian Health Care. It also gives a breakdown
of the number of Native American Medicaid recipients within each state
and takes a look at Native Americans in terms of health care.
National Library of Medicine- PubMed
NLM's free search service gives access to the
9 million citations in MEDLINE and Pre-MEDLINE (with links to participating
on-line journals), and other related databases. It was a valuable form
to search on current information about the health needs of Native Americans
and the current problems this population faces. It also provides articles
on Indian health care in relation to Medicaid reform and possible solutions
of improvement to the delivery system.
Relevant web documents
The initiative commits to setting high national
health goals for racial and ethnic minorities. It explains a five-step
plan to mobilize the resources and expertise of the Federal government,
the private sector, and local communities to eliminate disparities among
all the populations. It discusses HCFA’s distribution of $24 billion over
the next 5 years and the President's fiscal year 1999 budget proposes the
beginning of a new five-year, $400 million set of activities addressing
health disparities. Through a combination of education, outreach, and increased
access to health care for the uninsured, a major step to eliminating racial
and ethnic disparities in children's health will be achieved.
Impact on American Indian or Alaskan Native (AIAN) Health Research
The need for better statistical collection is
addressed in this document and it provides methods to improve the collection
and dissemination about the health of the AIAN population. By looking at
this article, it gives an understanding of why there may be misleading
information about the health care of Indians. Moreover, by implementing
the new programs suggested through this article, there is a better chance
of focussing on certain flaws in the AIAN health care system and formulating
new methods to improve access to care.
Comprehensive Health Care Program
for American Indians and
It gives a view of Indian health care programs
and the accomplishments of IHS, along with their flaws and problems. It
specifically discusses the issue of the IHS Health Care Delivery System,
Measuring Progress, and Health Care Programs. Once again
it Once again it gives a descriptive overview of the AIAN health care program.
In order to understand the Native American health
delivery system under Medicaid Reform, it is good to know what this reform
entails. This document provides all this information in the forms of what
provisions of the Medicaid statute are repealed, what changes to the Medicaid
program are made, and what new provisions to the Medicaid statute have
been added.
Medicaid Recipients of Medical Care by Race/Ethnicity and By State
Gives valuable information as described by the
title- specifically useful to look at Native Americans versus other minority
populations.
This document touches on two key topics which are self explanatory:
It is an informative report on Medicaid’s role for Native Americans and the policy issues for Native Americans in managed care. Before going in-depth about Native Americans and Medicaid managed care, the report also highlights the background on Indian health care. It is a very useful document in terms of understanding Indian health care as affected by Medicaid and managed care.