Challenges To Native American Health Care Even More Profound Than Those Facing The U.S. Health System In General

December 23, 1997

Looking for the first time at the management needs in the Native American health care sector, author Jay Noren writes in the January/February 1998 Public Health Reports that "Native American health care programs face formidable challenges unprecedented in their history." Since the 1976 enactment of the Indian Self-Determination and Education Assistance Act, increasing numbers of tribes are choosing to run their own health programs instead of the Indian Health Service. The move toward assumption of responsibility for the delivery of services has coincided with tighter resource constraints. Fifty-six percent of Native Americans and Alaska Natives live in large metropolitan areas yet current funding of Urban Indian Health programs meet only an estimated 22% of this demand. Recent dramatic changes in the funding of Medicare, Medicaid, as well as the major welfare reform bill also are putting clinic budgets at risk. Finally, the general growth of managed care is putting additional pressures on the managers of Native American health services.

Effective response to these powerful forces will require greater management sophistication in Native American health systems. In a survey conducted in 1997 of 85 leaders of Native American health care at 33 clinic sites, respondents cited their major challenges as follows: Given the rate of change in the health care market and Native American health care systems1 relatively recent entry into that market, management training for current Native American health care leaders is essential to the long-term viability of these programs. The survey also identified priority topics for management training. There was consensus that the following topics needed to be addressed: continuous quality improvement; customer orientation and satisfaction; managed care trends; conflict management among staff.

CONTACT: Jay Noren MD MPH, University of Wisconsin-Madison; tel. 608-265-3407; fax 608a-263-4885; e-mail <>.

Former Assistant and Deputy Assistant Secretaries for Health Call on Administration to Correct Structural Problems in the Indian Health Service

"Despite some efforts by the Clinton administration to coordinate Executive Branch activity with tribes through a Domestic Policy Council Working Group chaired by Secretary Babbitt, there has not been the kind of systematic review of how the current structure and function of Federally funded Indian programs fits the realities face by Indian people" write Philip Lee, former Assistant Secretary for Health, and Jo Ivey Boufford, former Principle Deputy Assistant Secretary for Health, in the January/February 1998 Public Health Reports.

The structural problems within the Indian Health Service (IHS) abound. The leadership and expertise are clearly available for this task, yet the key is joining together to seize an opportunity of a generation to assure that all the partners are meeting their obligations to promote and secure the health of Indian people. "Now is the time to launch a broad-based review of Federal programs for American Indians and Alaska Natives, applying the reinvention principles of government reform promoted by Vice President Gore and conducted in a partnership with tribes and Congressional leaders."

CONTACT: Jo Ivery Boufford MD, Dean, Robert F. Wagner Graduate School of Public Service; tel 212-998-7438; fax 212-995-4161; e-mail <

Public Health Reports

Related Medicaid Articles from Brightsurf:

For people with diabetes, medicaid expansion helps, but can't do it all: BU study
Medicaid expansion through the Affordable Care Act has insured millions of low-income people in the United States, improving outcomes for patients with many different diseases.

Changes in cancer survival after Medicaid expansion
Researchers compared the rate of death for patients diagnosed with breast, colorectal or lung cancer and living in states that expanded Medicaid under the Patient Protection and Affordable Care Act with states that didn't.

ACA's expansion of Medicaid improved maternal health
The period of time before pregnancy is critically important for the health of a woman and her infant, yet not all women have access to health insurance during this time.

Study: Medicaid and adults on the autism spectrum
Using administrative data from the Medicaid Analytic eXtract (MAX), researchers from Drexel University's A.J.

Long-term care after Medicaid expansion
This observational study looked at the association between Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) and long-term home health care and nursing home use among newly eligible low-income adults and older adults whose eligibility did not change.

After Medicaid expansion, 'unmet need' for joint replacement surgery
States that have expanded Medicaid eligibility under the Affordable Care Act have seen an 'early surge in demand' for hip and knee replacement surgery, reports a study in the September 2, 2020 issue of The Journal of Bone & Joint Surgery.

Medicaid expansion and outpatient surgical care
This observational study examined the association between state participation in Medicaid expansion through the Affordable Care Act and changes in the use of surgical care for common outpatient procedures.

Medicaid-covered mothers have less say in birthing experience: BU study
Giving birth in the United States is a radically different experience based on race and income, illustrated most brutally by the Black and Indigenous maternal mortality crisis.

Food allergy may be underdiagnosed in children on Medicaid
Prevalence of food allergy among Medicaid-enrolled children across the U.S.

Trouble getting a doctor's appointment may drive Medicaid enrollees to opt for the ER
The expansion of Medi-Cal, California's Medicaid program, gave millions of low-income Californians access to health insurance, but this study conducted in Northern California found that new patients may have to wait up up to a month for an appointment with a participating primary care provider, depending on their county of residence.

Read More: Medicaid News and Medicaid Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to