Moving Forward with Reforming the Indian Health Service

By Yvette Roubideaux, MD, MPH, director, Indian Health Service

The IHS Mission, in partnership with American Indian and Alaska Native people, is to raise their physical, mental, social and spiritual health to the highest level.

Yvette Roubideaux, MD, MPH

The focus of the Indian Health Service (IHS) during the past few years has been to change and improve the organization so it can better meet its mission. IHS focuses on direct delivery of healthcare services for approximately 2 million American Indians and Alaska Natives in 35 states through a network of more than 600 hospitals, clinics and health stations managed by IHS, tribal or urban Indian health programs. The population that IHS serves suffers from significant health disparities, and IHS delivers care under very challenging circumstances in mostly rural areas and with limited resources. However, progress has been made in IHS reform efforts over the past few years.

One of the most remarkable signs of progress has been increases to the IHS budget to address the growing need for services. Since 2008, the IHS budget has increased by 29% overall, with targeted increases in priority areas. For example, funding for referrals to the private sector through the IHS Contract Health Services Program has increased by 46% and has resulted in some facilities being able to pay for care beyond emergent priorities. As a result, access to needed care is increasing, including services for preventive care, which will help reduce overall costs in the future. While there is still a significant demand for services, these funding increases have helped increase access to basic healthcare.

Our focus on changing and improving the IHS during the past few years is necessary to ensure that we meet the needs of our patients and use federal resources efficiently and effectively. Input gathered in 2009 revealed the need for improvements in how IHS conducts business operations and ensures the delivery of quality healthcare. IHS has used a framework of four agency priorities to guide our efforts to change and improve IHS. These priorities are used in everyday discussions of agency activities, serve as priority goals for the overall organizational performance metrics and are used as a framework to monitor and communicate progress and outcomes.

 Strengthening Partnership with Tribes

Our first agency priority is to renew and strengthen our partnership with tribes. This priority is founded on our belief that the only way to improve the health of our communities is to work in partnership with them. We have seen evidence throughout our system that we accomplish more when we work in partnership with the communities we serve.

President Obama issued a Memorandum on Tribal Consultation in 2009 that directed all federal agencies to develop plans to consult with tribes. IHS has had a tribal consultation policy since1997, and we are focusing on improvements to the IHS tribal consultation process based on tribal recommendations. These improvements include better communication about consultation activities, listening sessions in all 12 IHS areas each year, increased participation in tribal meetings, a new website with updates on consultation activities, participation in over 400 tribal delegation meetings and national Tribal Consultation Summits to provide a forum for Tribes to provide input.

For 2013 and beyond, we will continue to implement tribal recommendations to improve the consultation process. Tribal consultation is critical, because our efforts to deliver healthcare are much more likely to be effective with the input and partnership of the communities we serve.

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