Improving Health Care for Native Americans Essay

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Underserved Populations

One of the most underserved populations in America with respect to health care is Native Americans. This community has a higher burden of illness, injury and premature death, and the health care needs of this population are seldom part of policy discussions because of its relatively small population (Katz, 2004). More are uninsured than most other groups as well, which creates problems with respect to access to care. Katz (2004) notes that almost half of low-income Native Americans are uninsured (prior to the ACA), and that over half of this group has incomes more than 200% below the poverty line, the impact of lack of access is widespread.

From a structure level, the US government has responsibility for providing health care to members of federally recognized tribes, and this is carried out by the Indian Health Service (IHS). The IHS is known to be chronically underfunded – in 2004 to the amount of $1.8 billion.Moreover, the Indian Health Service has limited reach (Katz, 2004). It only cares for around 1.5 million out of the 4.1 million people who are identified as Native American. The remainder are ineligible for care from the IHS because they are not members of federally recognized tribes.

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Many of the others are distant from IHS sites, as those sites are in areas with high concentrations of Native Americans, but those same services are unavailable outside of those areas. Katz (2004) notes that when the IHS was created, the majority of Native Americans lived on reservations but that today, a large percentage of the Native American population lives in urban areas.

With 60% of Native Americans living in urban areas, they are either ineligible for health care from IHS or do not have access to IHS facilities (ACOG, 2012). The outcomes for this community in urban areas tend to be poor – higher rates of teenaged pregnancy, late or no prenatal care, alcohol and tobacco use during pregnancy, higher infant mortality, higher SIDS and higher preterm birth. These outcomes are the result of a lack of access to care for urban Native American women (ACOG, 2012).

One of the issues facing underserved communities in general is that there are a lack of trained physicians for such communities. This means that majority ethnicity physicians ultimately end up playing an important role in care delivery, but also points to a….....

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ACOG (2012) Health care for urban American Indian and Alaska Native women. The American College of Obstetricians and Gynecologists. Vol. 515 (Jan 2012)

Allison, M., Rivers, P. & Fottler, M. (2007). Future public health delivery models for Native Americans tribes. Public Health. Vol. 121 (4) 296-307.

Katz, R. (2004) Addressing the health care needs of American Indians and Alaska Natives. American Journal of Public Health. Vol. 94 (1) 13-14.

Komaromy, M., Grumbach, K., Drake, M., Vranzian, K., Lurie, N., Keane, D., & Bindman, A. (1996) The role of the black and Hispanic physicians in providing health care for underserved populations. New England Journal of Medicine. Vol. 334 (1996) 1305-1310.

Marcinko, T. (2016) More Native American doctors needed to reduce health disparities in their communities. AAMC News. Retrieved November 27, 2017 from

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