Ambiguous Jurisdiction: Governmental Relationships that Affect American Indian Health Care Access

Perhaps the most significant law affecting the provision of health services to the American Indian and Alaska Native (AI/AN) population is the Indian Self-Determination and Education Assistance Act of 1975 (ISDEAA, PL 93-638). This Act allows tribes to assume the management and control of health care programs from Indian Health Service (IHS) and to increase flexibility in health care program development. Under ISDEAA, tribes have the option to contract or compact with IHS to deliver health services using pre-existing IHS resources (formula-based shares tables determine funding for various IHS sites), third party reimbursements, grants, and other sources. Typically, tribes develop their own non-profit health care corporations to provide services to their community, and as a result are eligible for grants and other types of funding not available to federal agencies like IHS.

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Summit on American Indian Health Care Bridging the Cultural Canyon: Strategies to Reduce Health Inequities for American Indians

Journal of Transcultural Nursing ◽

10.1177/1043659606289543 ◽

2006 ◽

Vol 17 (3) ◽

pp. 213-214 ◽

Cited By ~ 1

Author(s):

Terri H. Lipman ◽

Rosalyn J. Watts

Keyword(s):

Health Care ◽

American Indian ◽

American Indians ◽

Health Inequities ◽

Indian Health ◽

American Indian Health

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Health Care Access and Utilization for American Indian Elders: A Concept-Mapping Study

The Journals of Gerontology Series B ◽

10.1093/geronb/gbz112 ◽

2019 ◽

Vol 76 (1) ◽

pp. 141-151 ◽

Cited By ~ 1

Author(s):

David H Sommerfeld ◽

Elise Trott Jaramillo ◽

Erik Lujan ◽

Emily Haozous ◽

Cathleen E Willging

Keyword(s):

Health Care ◽

American Indian ◽

Concept Mapping ◽

Health Care Providers ◽

Health Care Access ◽

National Policy ◽

Health Care Use ◽

Care Providers ◽

Factors Affecting ◽

Care Access

Abstract Objectives Inequities in access to and utilization of health care greatly influence the health and quality of life of American Indian elders (AIEs). This study explores the importance and perceived prevalence of factors affecting health care use within this population and assesses the changeability of these factors to produce a list of action items that are timely and relevant to improving health care access and utilization. Method Concept mapping was conducted with AIEs (n = 65) and professional stakeholders (n = 50), including tribal leaders, administrators of public-sector health systems, outreach workers, and health care providers. Data were analyzed using multidimensional scaling and cluster analyses. Results The final concept-map model comprised nine thematic clusters related to factors affecting elder health care: Difficulties Obtaining and Using Insurance; Insecurity from Lack of Knowledge; Limited Availability of Services; Scheduling Challenges; Provider Issues and Relationships; Family and Emotional Challenges; Health-Related Self-Efficacy and Knowledge; Accessibility and Transportation Barriers; and Tribal/National Policy. Discussion Findings suggest that improvements in access to and utilization of health care among AIEs will require actions across multiple domains, including health system navigation services, workforce improvements, and tribal, state, and federal policy. A multilevel socioecological approach is necessary to organize and undertake these actions.

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