As part of the U.S. Department of Health and Human Services, the Indian Health Service (“IHS”) provides health care to approximately 2.2 million American Indians and Alaska Natives, all of whom are members or descendants of 573 federally recognized tribes. IHS operates a network of 55 health centers, 26 hospitals and 21 health stations located primarily in rural areas. According to IHS, its agency-wide goal is to ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indians and Alaska Natives.
However, according to a recent report published by the Government Accountability Office (“GAO”), IHS has struggled to provide quality and timely health care to American Indians and Alaska Natives, nearly a quarter of all positions for physicians, nurses, and other care providers at IHS facilities are vacant. In fact, the GAO report, looking at eight geographical areas, found that between 13 and 31 percent of health care provider positions are currently vacant, resulting in curtailed health care services.
The reason for such vacancies has primarily been attributed to the fact that many IHS facilities are located in rural areas, considered “isolated hardship” sites and designated as “unusually difficult” posts for health care providers. The problem is exacerbated by an inability to provide market salaries and/or housing for health care providers as well as a lack of funding for incentive programs, such as student loan repayment, in exchange for service contracts. Consequently, many IHS facilities are forced to rely on short-term employees, despite the fact that such a practice is often more costly than hiring full-time staff. However, some clinics and hospitals have not been able to hire short-term employees and have been forced to cut certain services, meaning patients are having to be diverted to other facilities located much farther away.
As reported by IHS, American Indians and Alaska Natives have a life expectancy that is 5.5 years less than all other races in the United States. This statistic alone underscores the importance of maintaining a strong clinical workforce capable of providing quality and timely health care services to American Indians and Alaska Native. IHS needs to address the issue of increasing vacancies and work hard to fulfill its goal of providing quality health care to American Indian and Alaska Native tribes. The governmental relationship between these tribes and the United States sets the legal basis for providing American Indians and Alaska Natives with health care, as the federal government promised to provide assistance, including medical services, in exchange for land cessions. It is time for IHS and the federal government to take action to fulfill this promise.