User:Gpp105/Indian Health Service

Scholarships
The IHS offers three types of scholarships to Native American students pursuing an education in healthcare : Preparatory Scholarship, Pre-Graduate Scholarship, and Health Professions Scholarship. The Health Professions Scholarship commits undergraduate and graduate students to a full-time service commitment after their professional training. These scholarships help to staff Indian health programs with Native American professionals. In addition, the IHS's Indians Into Medicine (INMED) program offers grants to universities to support Native American students in their medical education through mentorship, tutoring, financial aid, and more. It has also been used to support and encourage students before college to take pre-medical courses.

Affordable Care Act
An integral focus of economic and health policy for Native American healthcare is Medicaid. Under the Affordable Care Act (ACA) of 2010, states could choose to expand Medicaid benefits. Many Native Americans stood to benefit from this expansion of healthcare coverage. IHS and tribal facilities rely on beneficiaries like Medicaid to help cover the Congressional underfunding of the IHS itself. During the formation of the ACA, tribal leaders pushed for the reauthorization of the Indian Health Care Improvement Act and further provisions for AI/NA recipients, which facilitated IHS Medicaid funding. The ACA also authorized funding to support residency training programs in tribal or IHS facilities through teaching health centers (THCs). Such initiatives support provider retention as a greater percentage of graduates from these THCs chose to work in rural and underserved settings compared to the national average. Expansion of Medicaid under the ACA is dependent on whether or not the state authorizes it. If states do not approve expansion, fewer people receive comprehensive coverage and IHS and tribal facilities do not receive the extra sources of funding. The IHS and tribal clinics can direct money toward provider recruitment with better reimbursement for patient services.

Opponents of using Medicaid to alleviate health inequalities argue that it takes responsibility away from the government to provide comprehensive health services. They argue that underfunding of the IHS would still be persistent and possibly intensify under Medicaid expansion as patients go to private providers. Some tribal members assert that provisions under Medicaid are not what was promised to the Native American people as they are based on expanding affordability via insurance and not on providing comprehensive health services that are fully covered. By relying on services reimbursed by Medicaid, this increases participation in private health services instead of public. Due to the rural nature of reservations and lack of communication about the system, the enrollment and logistical processes involved in having Medicaid can also pose a barrier to Native Americans signing up, and disrupt members' eligibility status. Some proposed that to avoid these disruptions, the federal money from Medicaid directed to tribe members could be directed straight to the IHS budget, allowing funding to go directly to tribes and giving them say over eligibility.

In 2011, the Center for Medicare and Medicaid Services developed a mandate for tribal consultation regarding policy action in an effort to improve the quality of care for tribes. Another economic proposition to improve healthcare is to surpass consultation status for tribes when it comes to Medicaid policy and make them integral to the final decision making. This would help ensure that Medicaid programs are culturally aware and can treat behavioral medical issues better.

Current issues
Life expectancy for Native Americans is approximately 4.5 years less than the general population of the United States (73.7 years versus 78.1 years). Native communities face higher rates of chronic diseases like cancer, diabetes, and kidney disease. This is contributed to by the lack of public health infrastructure as well as the considerable distance to healthcare facilities for rural residents.

In 2013, the IHS experienced funding cuts of $800 million, representing a substantial percentage of its budget. Over the past twenty years, the gap between spending on federally recognized American Indian/Alaska Natives and spending on Medicare beneficiaries has grown eightfold. This inequity has a large impact on service rationing, health disparities and life expectancy, and can lead to preventive services being neglected. Other issues that have been highlighted as challenges to improving health outcomes are social inequities such as poverty and unemployment, cross-cultural communication barriers, and limited access to care.

Data from the 2014 National Emergency Department Inventory survey showed that only 85% of the 34 IHS respondents had continuous physician coverage. Of these 34 sites only 4 sites utilized telemedicine while a median of just 13% of physicians were board certified in emergency medicine. The majority of IHS emergency department from the survey reported operating at or over capacity. Tribal reservations are often sequestered in unfavorable and isolated locations. According to a study of provider vacancies in the IHS, conducted by the Department of Health and Human Services (2016), about half of the clinics studied identified their remote location as a large obstacle for hiring and retaining staff. Issues surrounding isolation, lack of shopping centers, schools, and entertainment also dissuades providers from moving to these areas. Such vacancies lead to cutting of patient services, delays in treatment, and negative effects on employee morale. Studies show that such problems surrounding Native Americans and reservation inequality may be addressed by growing a Native American healthcare workforce.

Since its beginnings in 1955, the IHS has been criticized by those it serves in medical deserts and by public officials.

Native Americans who are not of a federally-recognized tribe or who live in urban areas have trouble accessing the services of the IHS.