Looking for the first time at the management needs in the Native American health care sector, author Jay Noren writes in the January/February 1998 Public Health Reports that "Native American health care programs face formidable challenges unprecedented in their history." Since the 1976 enactment of the Indian Self-Determination and Education Assistance Act, increasing numbers of tribes are choosing to run their own health programs instead of the Indian Health Service. The move toward assumption of responsibility for the delivery of services has coincided with tighter resource constraints. Fifty-six percent of Native Americans and Alaska Natives live in large metropolitan areas yet current funding of Urban Indian Health programs meet only an estimated 22% of this demand. Recent dramatic changes in the funding of Medicare, Medicaid, as well as the major welfare reform bill also are putting clinic budgets at risk. Finally, the general growth of managed care is putting additional pressures on the managers of Native American health services.

Effective response to these powerful forces will require greater management sophistication in Native American health systems. In a survey conducted in 1997 of 85 leaders of Native American health care at 33 clinic sites, respondents cited their major challenges as follows:

• inadequate funding
• difficulty in recruitment and retention of professional staff due to remote locations
• inability to depend upon contracts between tribes and the U.S. Department of Health and Human Services
• changing relationships with the Indian Health Service as tribes move towards greater independence
• reductions and restructuring of Medicaid, Medicare, welfare make funding patterns uncertain
• ongoing tension between Native and non-Native staff.

Given the rate of change in the health care market and Native American health care syste
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Contact: Anthony Robbins, MD
arobbins@nlm.nih.gov
617-565-1441
Public Health Reports
23-Dec-1997