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| In 2011, the [[Centers for Medicare & Medicaid Services|Center for Medicare and Medicaid Services]] developed a mandate for tribal consultation regarding policy action in an effort to improve the quality of care for tribes.<ref>{{Cite web|title=Tribal Consultation {{!}} CMS|url=https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/Consultation|access-date=2021-05-11|website=www.cms.gov}}</ref> Another economic proposition to improve healthcare is to surpass consultation status for tribes when it comes to Medicaid policy and make them integral to the final decision making.<ref name=":03" /> This would help ensure that Medicaid programs are culturally aware and can treat behavioral medical issues better.<ref name=":23" /> | | In 2011, the [[Centers for Medicare & Medicaid Services|Center for Medicare and Medicaid Services]] developed a mandate for tribal consultation regarding policy action in an effort to improve the quality of care for tribes.<ref>{{Cite web|title=Tribal Consultation {{!}} CMS|url=https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/Consultation|access-date=2021-05-11|website=www.cms.gov}}</ref> Another economic proposition to improve healthcare is to surpass consultation status for tribes when it comes to Medicaid policy and make them integral to the final decision making.<ref name=":03" /> This would help ensure that Medicaid programs are culturally aware and can treat behavioral medical issues better.<ref name=":23" /> |
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| == Current issues ==
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| {{Main|Health of Native Americans in the United States}}
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| Life expectancy for Native Americans is approximately 4.5 years less than the general population of the United States (73.7 years versus 78.1 years).<ref name=quick-look /> Native communities face higher rates of chronic diseases like cancer, diabetes, and kidney disease.<ref>{{Cite web|date=October 2019|title=Disparities|url=https://www.ihs.gov/newsroom/factsheets/disparities/|access-date=May 11, 2021|website=Indian Health Service}}</ref> This is contributed to by the lack of public health infrastructure as well as the considerable distance to healthcare facilities for rural residents.<ref>{{Cite web|last=MD|first=Phuoc Le|title=Rural Health {{!}} Arc Health Justice|url=https://www.archealthjustice.com/rural-health-2/|access-date=2021-05-05|website=www.archealthjustice.com/|language=en-US}}</ref>
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| In 2013, the IHS experienced funding cuts of $800 million, representing a substantial percentage of its budget.<ref name="ICT032713">{{cite news|url=http://indiancountrytodaymedianetwork.com/2013/03/27/sequestration-grounds-assistant-secretary-indian-affairs-148392|title=Sequestration Grounds Assistant Secretary for Indian Affairs|author=Gale Courey Toensing|date=March 27, 2013|newspaper=Indian Country Today|access-date=2013-03-28|archive-date=2013-04-20|archive-url=https://web.archive.org/web/20130420152615/http://indiancountrytodaymedianetwork.com/2013/03/27/sequestration-grounds-assistant-secretary-indian-affairs-148392|url-status=dead}}</ref><ref name="NYT032013">{{cite news|url=https://www.nytimes.com/2013/03/21/opinion/the-sequester-hits-the-indian-health-service.html|title=The Sequester Hits the Reservation|author=Editorial Board|date=March 20, 2013|newspaper=The New York Times|access-date=2013-03-28|format=Editorial}}</ref> Over the past twenty years, the gap between spending on federally recognized American Indian/Alaska Natives and spending on Medicare beneficiaries has grown eightfold.<ref>{{Cite journal|last=Malerba|first=Marilynn|author-link1=Marilynn Malerba|date=November 2013|title=The Effects of Sequestration on Indian Health|journal=Hastings Center Report|volume=43|issue=6|pages=17–21|doi=10.1002/hast.229|pmid=24249470|issn=0093-0334}}</ref> This inequity has a large impact on service rationing, [[health disparities]] and life expectancy, and can lead to preventive services being neglected. Other issues that have been highlighted as challenges to improving health outcomes are social inequities such as poverty and unemployment, cross-cultural communication barriers, and limited access to care.<ref>{{Cite journal|last1=Sequist|first1=Thomas D.|last2=Cullen|first2=Theresa|last3=Acton|first3=Kelly J.|date=October 2011|title=Indian Health Service Innovations Have Helped Reduce Health Disparities Affecting American Indian And Alaska Native People|journal=Health Affairs|language=en|volume=30|issue=10|pages=1965–1973|doi=10.1377/hlthaff.2011.0630|issn=0278-2715|pmid=21976341|doi-access=free}}</ref>
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| Data from the 2014 National Emergency Department Inventory survey showed that only 85% of the 34 IHS respondents had continuous physician coverage.<ref name=":5">{{Cite journal|last1=Bernard|first1=Kenneth|last2=Hasegawa|first2=Kohei|last3=Sullivan|first3=Ashley|last4=Camargo|first4=Carlos|title=A Profile of Indian Health Service Emergency Departments|journal=Annals of Emergency Medicine|volume=69|issue=6|pages=705–710.e4|doi=10.1016/j.annemergmed.2016.11.031|pmid=28110985|year=2017|s2cid=205547184}}</ref> Of these 34 sites, only 4 sites utilized telemedicine<ref name=":5" /> while a median of just 13% of physicians were board certified in emergency medicine.<ref name=":5" /> The majority of IHS emergency department from the survey reported operating at or over capacity.<ref name=":5" /> Tribal reservations are often sequestered in unfavorable and isolated locations.<ref name=":022">US Department of Health and Human Services. (2016, October). INDIAN HEALTH SERVICE HOSPITALS: LONGSTANDING CHALLENGES WARRANT FOCUSED ATTENTION TO SUPPORT QUALITY CARE. Office of Inspector General. (OEI-06-14-00011).</ref>
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| According to a 2016 study of provider vacancies in the IHS, conducted by the Department of Health and Human Services, about half of the clinics studied identified their remote location as a large obstacle for hiring and retaining staff.<ref name=":022" /> Issues surrounding isolation, lack of shopping centers, schools, and entertainment also dissuades providers from moving to these areas. Such vacancies lead to cutting of patient services, delays in treatment, and negative effects on employee morale.<ref>United States Government Accountability Office. (2018, August). INDIAN HEALTH SERVICE: Agency Faces Ongoing Challenges Filling Provider Vacancies. Indian Health Service Workforce. (GAO-18-580).</ref> A 2021 study found that such problems surrounding [[Native Americans and reservation inequality]] may be addressed by growing a Native American healthcare workforce.<ref>{{Cite web|title=More Native American Doctors Needed to Reduce Health Disparities in Their Communities|url=https://www.aamc.org/news-insights/more-native-american-doctors-needed-reduce-health-disparities-their-communities|access-date=2021-05-05|website=AAMC|language=en}}</ref>
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| Since its beginnings in 1955, the IHS has been criticized by those it serves in [[Medical deserts in the United States|medical deserts]] and by public officials.<ref>{{cite web|last1=Fraser|first1=Jayme|title=Indian Health Service care criticized as 'genocidal' despite improvement efforts|url=http://missoulian.com/news/state-and-regional/indian-health-service-care-criticized-as-genocidal-despite-improvement-efforts/article_7e420932-83d1-5c30-a3ca-339a2e8264e0.html|website=missoulian.com|date=5 September 2016 |access-date=2017-11-01|language=en}}</ref><ref>{{cite web|title=Sickly service|url=http://www.swoknews.com/local/sickly-service|website=The Lawton Constitution|access-date=2017-11-01|language=en|archive-date=August 31, 2017|archive-url=https://web.archive.org/web/20170831172750/http://www.swoknews.com/local/sickly-service|url-status=dead}}</ref><ref>{{cite web|title=The Indian Health Service Paradox|url=https://khn.org/news/091709trahant/|website=Kaiser Health News|access-date=2017-11-01|date=16 September 2009}}</ref><ref>{{cite web |url=http://www.commonwealthfund.org/usr_doc/roubideaux_qualityhltcare_aians_756.pdf |title=A review of the quality of health care for American Indians and Alaska natives |website=www.commonwealthfund.org |access-date=2017-11-01 |archive-url=https://web.archive.org/web/20160531184409/http://www.commonwealthfund.org/usr_doc/roubideaux_qualityhltcare_aians_756.pdf |archive-date=2016-05-31 |url-status=dead }}</ref>
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| Individuals who are not of citizens of federally recognized tribe or who live in urban areas may have trouble accessing the services of the IHS.<ref name=":6" />
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| == See also == | | == See also == |