The following question needs to answered: Many Native American tribes are opting to run their...

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The following question needs to answered:						Many Native American tribes are opting to run their own health care services rather than allowing Indian Health Services (IHS) to do it for them. Why do you think tribes are making this choice?			Indian Health Services Tribal Nations and the Delivery of Healthcare 566 Federally-recognized Tribes in 36 States Sovereign Nations Distinct culture, language and traditions Live on trust land and in urban areas Economic Diversity Tribal Membership * AI/AN alone				3.2 million AI/AN in combination 	with one or more other 	races 					2.0 million  Total AI/AN 				5.2 million Reported a specific  	tribal affiliation		      		74% IHS Service Population	   	  2 million 	Mission:  To raise the physical, mental, social, and spiritual health of American Indians and Alaska natives to the highest level 	Goal:  To assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people 	Foundation: To uphold the Federal Government’s obligation to promote healthy American Indian and Alaska Native people, communities, and cultures and to honor and protect the inherent sovereign rights of Tribes Indian Health Service Pre-Contact/Tradition Medicine Impact of European Settlement Constitution/Treaties/Legislation Supreme Court Sovereignty Federal Trust Responsibility Government to Government Relationship * 	1800’s – Responsibility of the War Department 	Indian Removal Indian Removal Act of 1830 1836 – Medical services for land cessions 	1849 - BIA/Department of Interior 	Dawes Act – General Allotment Act 1887 Reservation land divided into allotments Ban on traditional practices Introduction of boarding schools * 	Treaty/trust responsibility 	Reservation health care is a federal responsibility.  	Federal policy of tribal self-determination Began in the mid-1970s for a number of services previously managed by the federal government. 	Since the 1980s, a growing number of Native nations have taken over management of various aspects of health-care delivery 	Under the US Department of Health and Human Services  	Comprehensive, primary health care system and some public health services Only federal agency to provide direct medical care 	Trust Responsibility: Members of federally recognized tribes * 	IHS serves 2m people from 566 tribes 	12 area offices and 163 IHS and tribally managed service units 	Tribally-operated health care services 	Tribal facilities are operated under the authority of the Indian Self-Determination and Education Assistance Act (Public Law 93-638, as amended) A Quick Look at the Size of IHS 	FY 2012 spend authority is approximately $5.0  billion.  	Indian Health Service total staff consists of  about 15,700 employees, which includes approximately 2,400 nurses, 800 physicians, 400 engineers, 500 pharmacists, 300 dentists, and 300 sanitarians.   * * Broken into three types of health programs: 	Indian Health Service – Federally operated Facilities  	 	Tribally Operated Facilities – Established under PL 93-638, Indian Self-Determination Act 	Urban Health Programs – Established under the Indian Health Care Improvement Act * 	82 Title V compacts (337 tribes; nearly 60% of tribes) 	231 Title I contracts 	33 Urban Indian health care services and resource centers, ranging from community health to comprehensive primary care services 	Approximately 600,000 American Indians and Alaska Natives reside in counties served by urban Indian health programs. 	Direct Healthcare Services:  Onsite services provided at an I/T/U 	Contract Health Services:  Services delivered by a non-I/T/U facility or provider through contracts. 	Special money allocated by Congress to use specifically for patient care not covered by other programs. 	CHS are provided principally for members of federally recognized tribes who reside on or near the reservation established for the local tribe(s) in geographic areas called contract health service delivery areas (CHSDAs) .    	The eligibility requirements are stricter for CHS care than for direct services. No IHS direct-care facility exists The direct care facility is incapable of providing the required emergency and/or specialty care. The direct care facility has an overflow of medical care workload To supplement alternate resources. 	Those members of federally recognized tribes as determined by the local I/T/U. 	Non-Indian woman pregnant with an eligible Indian’s child—during pregnancy and 6 weeks post partum. 	Must reside on the reservation/territory located within the CHSDA. (Exemptions include full-time students, children in foster care, close social and economic ties, and 180 day coverage for those members who have moved away.) 	Services must fall within the established medical priorities. 	Must exhaust alternate resources* because federal law requires that IHS is payor of last resort. *Alternate Resources include: Medicaid, Medicare, Private Insurance, Other 3rd party resources. 	In “emergency cases” the patient must notify the respective CHS office within 72 hours after the beginning the treatment or after admission to a non-I/T/U facility. 	Services or supplies furnished by any other program/s 	Nursing home care 	Abortions 	Procedures that are strictly Cosmetic 	Burials and related expenses 	Housekeeper and companion services *This is not an exhaustive list The Indian Self-Determination and Educational Assistance Act 1975 P.L. 93-638 Tribes can manage their health programs Title I:  CONTRACT  part or all of the services Title V: COMPACT entire health programs Funding issues: shares, contract support costs * 	Why are some Native nations shifting from IHS provision to tribal management of health care? 	How is the shift to tribal management changing health-care delivery? 	What new challenges (if any) are emerging? 	What solutions (if any) are tribes developing? 	Does tribal management lead to better health-care delivery than direct HIS Management? 	Six comparison studies, published 1996-2002, analyzed data from 1980s-2001 	Four studies said tribal management leads to improved quality, expanded coverage, and easier access to health care services. 	All six studies identified considerations for tribes to contemplate when moving toward tribal management or while managing health care services. 	Five categories: funding, institutional, treaty and trust responsibilities, information needs, and access to health care services. Tribal responsibility for community health Change from federal action to indigenous action,  while holding the federal  government to their treaty  commitments Tribal engagement in the delivery of health care Tribal health and other department program,  638 tribes have some type of contracting of health services, compacting of health services, etc. National Factors 	Shortcoming in the IHS system Local circumstances, such as small communities and remote location that complicate access to services Tribal Factors 	The drive for self-governance and local control 	What other tribes are doing and have experienced, especially those that are geographically close 	For some, the conflict between federal responsibility and tribal role in health care delivery 	Search for additional funding sources and pool available funds 	Partner with other tribes, non-tribal governments, educational institutions, etc. 	Increase tracking of results 	Re-conceive the “service area: 	Change locally available services and add a broader range of services 	Accountable to tribal citizens 	Complexity of health-care systems means that managing such systems requires skilled, professional management and good customer service. 	Strong health programs depend in part on stability and professionalism 	in tribal government—and keeping tribal politics under control. 	Funding remains a major challenge. 	Funding stipulations can define who can receive services, and require collection and reporting of data that may not be meaningful or useful to 	the tribe. 	While numerous tribes are addressing healthcare management issues, it is not easy for them to learn from each other through sharing stories. Emergent/Acutely Urgent Care – Services necessary to prevent the immediate death or serious impairment of the health of an individual. Preventive Care Service – Primary health care aimed at the prevention of disease or disability.  When a person needs something to keep them from moving to level Primary Secondary Care Services – Inpatient and  outpatient care services care services that have a significant impact on morbidity and mortality.  Chronic Tertiary and Extended Care Services – in-patient and outpatient care services that are not essential for (1) initial/emergent diagnosis or therapy, (2) have less impact on mortality than morbidity, or (3) are high cost, elective, and often require tertiary care facilities.   * * 1.pdf January 2006 2005 IHS Expenditures Per Capita Compared to  Other Federal Health Expenditure Benchmarks  $5 ,6 70 $4 ,6 53 $4 ,3 28 $3 ,2 42 $2 ,9 80 $847 $753 $581 $682 $743 $923 $-  $ 6, 78 4  $2 ,1 30 $- $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 Medicare National Health Expenditures Veterans Administration Medicaid Medical for Federal Prisons FEHB Medical Benchmark 2005 IHS Expenditures IHS 2003 19992002 1999 Growth Forecast Through 2005 2002 Last  Actual  Data $498 IHS Medical Non- medical See notes on reverse for data sources and forecast assumptions. 2002 January 2006 Data Sources for Health Care  Expenditures Per Capita Chart 1. MEDICARE EXPENDITURES PER ENROLLEE:  Source – Centers for Medicare and Medicaid Services website, 2/6/2006  [http://www.cms.hhs.gov/MedicareMedicaidStatSupp/05_2004%20Edition.asp#TopOfPage].  Table 16 reports $6,784 as the average Medicare payment  per beneficiary in 2002 (the last year of published data).  The historical average growth rate has varied.  The 2002 per beneficiary payment is extrapolated  to $7,631 in 2005 assuming payments grew at an annual rate of 4%.  2. MEDICAL CARE FOR VETERANS ADMINISTRATION USERS: Source – Veteran's Administration website, 2/6/2006  [http://www.va.gov/vetdata/ProgramStatics/stat_app02/Table%2011%20(02).xls].  Table 1 reports $4,653 as the national average health cost per user in  2002 (the last year of published data).  The historical average growth rate has varied.  The 2002 per beneficiary payment is extrapolated to $5,234 in 2005  assuming costs grew at an annual rate of 4%. 3. NATIONAL HEALTH CARE EXPENDITURES PER CAPITA : Source – Centers for Medicare and Medicaid Services website, 2/6/2006  [http://www.cms.hhs.gov/NationalHealthExpendData/downloads/nheprojections2004-2014.pdf].  Table 1 reports $5,670 as the national average health care  expenditure per person in 2003 (the last year of published data).  CMS also projects future expenditures considering various economic factors.  CMS  projects $6,423 in 2005. 4. MEDICAID PAYMENTS PER BENEFICIARY: Source – Centers for Medicare and Medicaid Services website, 2/6/2006  [http://www.cms.hhs.gov/MedicareMedicaidStatSupp/05_2004%20Edition.asp#TopOfPage].  Table 111 reports $4,328 as the average Medicaid payment  per person in 2002 (the last year of published data).  The historical average growth rate has varied.  The 2002 per beneficiary payment is extrapolated to  $5,010 in 2005 assuming payments grew at an annual rate of 5%.  5. MEDICAL CARE FOR FEDERAL PRISON INMATES: Source – General Accounting Office, Report and Testimony GAO/T-GGD-00-112, Federal Prisons- Containing Health Care Costs for an Increasing Inmate Population,  April 2000. According to GAO, the medical care expenditures for federal prison inmates  was $3,242 per capita in 1999. Data for subsequent years is unavailable.  Assuming a conservative growth of 3.5% annually (

Dr Insiyah R. · Accepted Answer

Title: Indian health service (IHS)
 
Introduction	1
Conclusion	2
References	3
Introduction 
Located inside the Department of Human Services, the Indian Health Service (IHS) is a medical initiative (Bruce et al,2021). At IHS facilities, it offers qualified American Indians and Alaska Natives government health services (Fonda et al,2020). IHS offers medical, dental, and eye care and auxiliary services like laboratory, pharmacy, and speciality care, including services rendered by doctors or other specialists (Kaufman et al,2022). The type of healthcare is influenced by the requirements of the community, available resources, and if the therapy is medically essential. When THE INDIAN HEALTH SERVICE (IHS) was founded in 1955, it was up against an enormous challenge.
Poor rural Indian inhabitants suffered greatly from illness. Infant mortality increased to four times the national norm as tuberculosis persisted in its resurgence. The IHS has significantly improved health conditions over the past 50 years, although gaps exist. The health conditions of American Indians are still among the poorest in the country. 
The differences have lasted for 500 years rather than 50, which is more astonishing than their longevity (Bruce et al,2021).
American Indians have endured more hardships from the beginning of colonisation, regardless of whether smallpox, tuberculosis, alcoholism, or other chronic ailments of contemporary society were in vogue.
 Since access to quality medical care is a fundamental human right, everyone should have it. This is not always the case in the United States, though, since some communities, including those of Native Americans, do not have access to the same level of medical treatment as other populations. As a result, it is the duty of the Indian Health Service (IHS), a division of the U.S. (Fonda et al,2020). Department of Health and Human Services,

Indian Health ServicesTribal Nationsand theDelivery of Healthcare566 Federally-recognized Tribes in 36 StatesSovereign NationsDistinct culture, language and traditionsLive on trust land...

Answer To: Indian Health ServicesTribal Nationsand theDelivery of Healthcare566 Federally-recognized...

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