Unequal Treatment Confronting Racial and Ethnic Disparities in Health Care (2003) / Chapter Skim
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Pages 528-551
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The Rationing of Healthcare and Health Disparity for the American Indians/Alaska Natives Jennie R Joe, Ph.D., M.P.H.1 Native American Research and Training Center University of Arizona At a recent meeting held to examine health disparities for American Indians and Alaska Natives, Dr.
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529 RATIONING OF HEALTHCARE AND HEALTH DISPARITY Today there are slightly over two million self-identified American Indians and Alaska Natives in the United States. While a majority live in the western states, only 38 percent continue to reside on federal trust lands; the rest now reside predominantly in off-reservation or urban communities.
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530 UNEQUAL TREATMENT than for the U.S., all races: 1) alcoholism -- 627 percent; 2)
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531 RATIONING OF HEALTHCARE AND HEALTH DISPARITY odic reports by the staff mentioned unhealthy conditions on many reservations, but these problems were not addressed, due to lack of authorization and funding. The harsh living conditions on Indian Reservations, however, continued to exacerbate the declining health status of the population, fueled directly and indirectly by inadequate nutrition, unsanitary conditions, substandard housing, and lack of healthcare.
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532 UNEQUAL TREATMENT In contrast to the conviction shared by many tribal leaders, the federal government has maintained that federal support for health services for American Indians/Alaska Natives is not an entitlement but is voluntary (or discretionary)
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533 RATIONING OF HEALTHCARE AND HEALTH DISPARITY responsibility and/or its involvement in the "Indian" business (McNickle, 1973)
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534 UNEQUAL TREATMENT scholarships to train more American Indian/Alaska Native healthcare providers; 4) allowing for Medicare and Medicaid reimbursements to IHS or to tribal health programs; and 5)
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535 RATIONING OF HEALTHCARE AND HEALTH DISPARITY less than 50 beds and most do not provide surgical or obstetric services. Other services offered by IHS, albeit on a decreasing scale include public nursing, a public health sanitation program, environmental health, dental and optometry services, etc.
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536 UNEQUAL TREATMENT Healthcare Dollars Over the decades, the existing healthcare system, whether managed by IHS, tribes, or urban programs, has had to broaden its base of financial support in order to respond to the needs of the growing population of American Indians and Alaska Natives. Financing and paying for patient care by private or non-IHS or non-tribal facilities or providers is partially possible with funds allocated under Contract Health Service (CHS)
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537 RATIONING OF HEALTHCARE AND HEALTH DISPARITY American Indians/Alaska Natives were least likely of all racial groups to access Medicaid -- only 65% of eligible Indians have Medicaid coverage compared with 82% for African Americans, 83% for Asians and Pacific Islanders, and 91% for Hispanics (HCFA, 1995)
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538 UNEQUAL TREATMENT facilities than those with less schooling. The latter often experienced more dissatisfaction, some of it due to language differences, high provider turnover, and cultural insensitivity.
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539 RATIONING OF HEALTHCARE AND HEALTH DISPARITY barbaric and un-Christian. It was not until the mid-1930s that ceremonies such as the Sun Dance could be conducted without fear of reprisal.
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540 UNEQUAL TREATMENT [Retired CEO for Regional Health Organization] : I would say yes, but ser vices are not always accessible.
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541 RATIONING OF HEALTHCARE AND HEALTH DISPARITY want to pay because they think Medicaid should pay. Medicaid don't want to pay because they think PHS [IHS]
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542 UNEQUAL TREATMENT Elsewhere, the CHS dollars are reserved primarily for life-threatening emergencies that might involve automobile accidents or other major accidents or situations that may result in permanent disability or loss of a limb. Decisions as to who will receive CHS coverage are handled in a number of ways, depending on the location.
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543 RATIONING OF HEALTHCARE AND HEALTH DISPARITY sponsible for any medical bills associated with the emergency care. Moreover, it is not unusual for many of these non-IHS or non-tribal facilities to also deny services to Indian patients unless they receive prior authorization.
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544 UNEQUAL TREATMENT years, there are improvements in clinical care. If you walk into the Alaska Na tive Medical Center today, you get treated today, whereas under the old system, sometimes it was a couple of weeks before you could get an appointment (NC 6/12/01)
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545 RATIONING OF HEALTHCARE AND HEALTH DISPARITY racial discrimination or the lack of cultural sensitivity, especially by providers or employees in the private sector. The next section highlights some of these observations made by interviewees during the telephone interviews.
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546 UNEQUAL TREATMENT insurance' .... Whether an Indian patient gets health service in the private sector is often dependent on stereotypical views held by these providers (HN 9/3/01)
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547 RATIONING OF HEALTHCARE AND HEALTH DISPARITY than breast conserving therapy, even for early stage cancer. As a clinician himself, he speculated that the surgeons might opt for mastectomy because of a stereotypical view of Indians -- that Indian women, who often live miles away from the treatment facilities, may be lost to follow-up because they likely will not return for the series of radiation or chemotherapy treatments.
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548 UNEQUAL TREATMENT 14 different eastern states and across four different federal regions (MT 8/ 31/01)
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549 RATIONING OF HEALTHCARE AND HEALTH DISPARITY Summary Unlike other racial or ethnic minority groups, the federal government (through IHS) is responsible for delivery of health services to federally recognized American Indians and Alaska Natives through IHS, tribal, and urban-based Indian programs.
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550 UNEQUAL TREATMENT REFERENCES Albuquerque Journal.
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551 RATIONING OF HEALTHCARE AND HEALTH DISPARITY Office of Technology Assessment (OTA)
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