Indian Health Services: The Government Funded Healthcare Harming Indigenous Communities

In 1955, the Indian Health Services (IHS) was established to support the health of Native American communities. The IHS is a federally funded and managed health organization that serves Native Americans across the United States. Health services are provided by the IHS through a variety of hospitals, clinics, and ambulance services. The care is free to registered members of American Indian and Alaska Native (AI/AN) tribes. However, IHS patients are ineligible for other governmental health coverage such as Medicare and Medicaid. As a division of the US Public Health Services, the IHS also plays a role in Native American public health education. Yet despite access to federally funded healthcare, Native Americans maintain the lowest life expectancy of any ethnic group in the United States, as of 2022. Native populations maintain high rates of suicide, heart disease, liver disease, cancer, and diabetes; calling into question if the IHS is fulfilling its promise to support the health of Native communities.

In recent years, researchers have begun to investigate just that. With many native populations living in rural areas, access to emergency medical care is of primary concern. Distance itself presents the first barrier. If an ambulance is selected as primary means of transport to the ER, it takes an average of 70 minutes from the time 911 is called to the time the patient is transferred to the care of ER staff. This exceeds the 60 minute window from time of injury or illness to time of ER arrival healthcare providers recommend for positive health outcomes. Unfortunately, for AI/AN communities, the uphill battle to emergency care doesn’t stop with hospital arrival. In a survey of 34 out of the 40 IHS operated ERs, it was found that only 13% of the ER staff physicians were board certified in emergency medicine. Many of the surveyed ERs additionally reported they did not have continuous physician care available, with even more sparse access to specialists. These compounding factors paint a clear picture of how delayed access to necessary emergency care could be deadly for an AI/AN individual.

The shortcomings of the system extend to the primary care the IHS aims to provide through outpatient clinics. Many clinics maintain limited accessibility due to distance from residences in rural areas. While the IHS does have distance regulations to mitigate this, one factor often overlooked is that many AI/AN living on a reservation have limited or no access to reliable transportation. Furthermore, clinics are overextended with insufficient resources for the population numbers they serve. Pine Ridge Indian Reservation member Dr. Keely Ulmer recalled an experience of a family member needing to seek regular audiological care at a hospital 2 hours away. The audiology specialist was only available one day per month, and was designated to serve a surrounding population of 30,000 reservation members. Concerns for the quality and availability of care isn’t limited to native community members. The U.S Government Accountability Office itself has raised additional concern over the quality of medical equipment available at IHS facilities. High numbers of in-use equipment uses antiquated technologies, and malfunctioning equipment faces long wait times for repair. It’s the members of AI/AN communities that run the risk of delayed or inadequate diagnostic testing due to equipment failure.

Impatient with the government’s slow progress to improve IHS care, some native communities have expressed desire to transfer the management of reservation healthcare facilities to AI/AN community members. Whether or not these shifts take place is still to be seen. The future of the IHS and its role on reservations lies in wait while the health of our nation’s indigenous peoples suffers.