Indian Health Service
The Indian Health Service (IHS) is an Operating Division (OPDIV) within the U.S. Department of Health and Human Services responsible for providing federal health services to American Indians and Alaska Natives. The Indian Health Service was established in 1955 to take over health care of American Indian and Alaska Natives from the Bureau of Indian Affairs. The provision of health services to members of federally recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes. This relationship, established in 1787, is based on Article I, Section 8 of the Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders. The IHS is the principal federal health care provider and health advocate for Indian people, and its goal is to raise their health status to the highest possible level. The IHS currently provides health services to approximately 1.8 million of the 3.3 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states. The agency's annual budget is about US$3 billion.
The IHS provides health care to Native Americans and Alaska Natives at 33 hospitals, 59 health centers, and 50 health stations. Thirty-four urban Indian health projects supplement these facilities with a variety of health and referral services.
The IHS employs approximately 2,700 nurses, 900 physicians, 400 engineers, 500 pharmacists, and 300 dentists, as well as other health professionals totalling more than 15,000 in all.
Employment at IHS: The Indian Health Service is one of two federal agencies mandated to use Indian Preference in hiring. This law requires the agency to only consider Indian applicants for a position, unless there are no Indian applicants. This policy makes it legally possible to create a workforce of minimally qualified persons based only on race. IHS's workforce is 70% Indian. IHS draws a large number of its professional employees from the U.S. Public Health Service Commissioned Corps. This is a non-armed service branch of the U.S. Military. Professional categories of IHS Commissioned corps officers include physicians, nurses, dentists, pharmacists, engineers, sanitarians and dietitians. Many IHS jobs are in remote areas. In 2007, most IHS job openings were on the Navajo reservation.
Efficiency at IHS: ExpectMore.gov shows four rated areas of IHS: federally administered activities (moderately effective), health care facilities construction (effective), resource and patient management system (effective), and sanitation facilities construction (moderately effective). All Indians/Alaska Natives are legally entitled to free health care. This health care is provided by Indian Health Service, either through IHS-run hospitals and clinics, or through tribal contracts to provide health care services. IHS-run hospitals and clinics serve any registered Indian/Alaska Native, regardless of tribe or income. Tribal contract health care facilities serve only their tribal members, with other qualified Indians/Alaska Native being offered care on a space available basis. This policy makes it difficult or impossible to for an Indian who leaves his tribal home for education or employment to receive the health care services to which he is legally entitled. An IHS fact sheet clarifies that Indians are also eligible to apply for any low income health care coverage provided by state and local governments, such as Medicaid (Medi-Cal in CA). This allow tribal clinics to "double dip"- receiving money for services from both IHS and Medicaid.
Some of those who are served by this system are not satisfied with the efficiency of IHS. An opinion writer for Indianz.com, a website for Native American news, feels Native Americans are "suffering" at the hands of IHS. (Indianz.com: 8-20-07, Jodi Rave: Indian Health Service Inadequate) She feels IHS is underfunded and necessary services unavailable. Others have concerns that restrictions of the Indian preference policy do not allow for the hiring of the most highly qualified health professionals and administration staff, so quality of care and efficiency of administration suffer.
Indian Health Service is led by a commissioned officer of the U.S Public Health Service, Rear Admiral Charles W. Grim. RADM Grim also holds the title of Assistant Surgeon General. He is a dentist with an additional masters degree in health services administration, and a tribal member of the Cherokee Nation of Oklahoma.
The Indian Health Service uses a custom medical software database known as RPMS.
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