Spotlight: Indian Health Service

As we mentioned in an earlier piece,we’re focusing on two federal agencies that serve Native Americans this week, in honor of Native American Day. The Indian Health Service (IHS), which is part of the U.S. Department of Health and Human Services, is responsible for providing federal health services to approximately 1.9 million American Indians and Alaska Natives in 35 states. IHS was established in 1955 to take over healthcare of American Indian and Alaska Natives from the Bureau of Indian Affairs (BHS); it was made part of the Public Health Service (PHS) in hopes of improving healthcare services for these individuals.

IHS headquarters are located in the Reyes Building at 801 Thompson Ave. in Rockville, Md. The agency is broken into 12 areas, with area offices in Aberdeen, S.D.; Albuquerque, N.M.; Anchorage, Alaska; Bemidji, Minn.; Billings, Mont.; Nashville, Tenn.; Oklahoma City, Okla.; Phoenix; Portland, Ore.; Sacramento, Calif.; and St. Michael and Tucson, Ariz.

The IHS provides health services to its clients in more than 670 different facilities in three ways: directly, through tribally contracted and operated health programs, and through services purchased from private providers. These facilities include more than 1.7 million square feet of space, of which the government owns or leases 64% and the tribes own or lease 36%. The system contains 29 hospitals, 68 health centers, and 41 health stations. Another 33 urban Indian health projects provide health and referral services. American Indian tribes and Alaska Native corporations administer an additional 16 hospitals, 258 health centers, 74 health stations, and 166 Alaska village clinics through contracts with IHS. The agency’s clinical staff consists of about 2,950 nurses, 860 physicians, 660 pharmacists, 340 physician assistants/nurse practitioners, and 310 dentists.

While many believe the IHS is inadequately funded, inefficient, and unable to properly serve its clients, others view the IHS as a successful model for rural health programs—as well as for healthcare programs for indigenous peoples throughout the world—because of its respect for cultural beliefs, its blending of traditional practices with modern medical approaches, and its emphasis on public health and community outreach. Although it has resulted in significant health improvements for Indian people, whose life expectancy has increased by about nine years since 1973, Indians continue to suffer much higher rates of death from many diseases than the general U.S. population. Because the average age of IHS healthcare facilities is greater than 32 years, new facilities and equipment are urgently needed. The agency is “developing new ways to meet space needs, including cooperative ventures with Tribes and others.”