Some Native American tribes are taking over the management of Indiana Health Service hospitals in hopes of reversing a long history of poor care quality, low funding and understaffing at the federal facilities, according to The New York Times.
IHS' 24 hospitals provide healthcare to 2.2 million American Indians and Alaska Natives in the U.S. In 2017, the Government Accountability Office put the IHS on its list of high-risk operations that need transformation, where it still remains.
Compared to almost any other population, the government spends the least on Native American healthcare. In 2017, IHS spent $3,332 per patient, a National Congress of American Indians report found. In contrast, Medicare and Medicaid spent $12,829 and $7,789 per patient, respectively. Understaffing is also common at IHS hospitals. At present, about one-fourth of medical positions at the federal health system are vacant, according to The New York Times' analysis of federal data.
The poor funding and understaffing can have dire consequences for IHS patients. Native Americans living in South Dakota have an average life expectancy of 57, compared to 81 for white residents in the state.
Instead of waiting for federal officials to improve management of IHS, many tribes are seizing control of hospitals. This strategy gives tribal nations greater financial flexibility and eligibility to receive additional funding sources, Rear Adm. Michael Weahkee, a member of the native Zuni Tribe and IHS official, told The New York Times. Since 2009, seven IHS hospitals in South Dakota, Nebraska and Arizona have transitioned to tribal management.
Despite many challenges, tribes who have taken control of their healthcare systems have seen improvement.
"I know tribes that … have been very successful at creating a really wonderful health system to the point where they are experiencing better health outcomes," Lynn Malerba, chief of the Mohegan Tribe and chairwoman of the Tribal Self Governance Advisory Committee, told The New York Times. "Tribal citizens who receive their healthcare through a tribal program are much happier."