Indian Health Service
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The Indian Health Service (IHS) is an agency within the U.S. Department of Health and Human Services responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally-recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes. This relationship, established in 1787, is based on Article I, Section 8 of the Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders.
The principal legislation authorizing Federal funds for health services to recognized Indian Tribes is the Snyder Act of 1921. It authorized funds "for the relief of distress and conservation of health...[and]...for the employment of...physicians...for Indian Tribes throughout the United States."
Congress passed the Indian Self-Determination and Education Assistance Act (Public Law 93-638, as amended) to provide Tribes the option of either assuming from the IHS the administration and operation of health services and programs in their communities, or to remain within the IHS administered direct health system. Congress subsequently passed the Indian Health Care Improvement Act (P.L. 94-437), which is a health-specific law that supports the options of P.L. 93-638.
The IHS is the principal federal health care provider and health advocate for Indian people, and its goal is to raise their health status to the highest possible level. The IHS currently provides health services to approximately 1.8 million American Indians and Alaska Natives who belong to more than 560 federally recognized tribes in 35 states, mostly in the western U.S. and Alaska.
In order to carry out its mission, attain its goal, and uphold its foundation, the IHS:
1. Assists Tribes in developing their health programs through activities such as health management training, technical assistance, and human resource development; 2. Assists Tribes in coordinating health planning, in obtaining and using health resources available through Federal, State, and local programs, and in operating comprehensive health care services and health programs. 3. Provides comprehensive health care services, including hospital and ambulatory medical care, preventive and rehabilitative services, and development of community sanitation facilities. 4. Serves as the principal Federal advocate in the health field for Indians to ensure comprehensive health services for Indian people.
Preventive measures involving environmental, educational, and outreach activities are combined with therapeutic measures into a single national health system. Within these broad categories are special initiatives in traditional medicine, elder care, women's health, children and adolescents, injury prevention, domestic violence and child abuse, health care financing, state health care, sanitation facilities, and oral health. Most IHS funds are appropriated for American Indians who live on or near reservations. Congress also has authorized programs that provide some access to care for Indians who live in Urban areas.
IHS services are provided directly and through tribally contracted and operated health programs. Health services also include health care purchased from private providers. The Federal system consists of 33 hospitals, 59 health centers, and 50 health stations. In addition, 34 Urban Indian health projects provide a variety of health and referral services.
The IHS clinical staff consists of approximately 2,700 nurses, 900 physicians, 400 engineers, 580 pharmacists, 300 dentists, and 150 sanitarians. The IHS also employs various allied health professionals, such as nutritionists, public health analysts, health administrators, and medical records administrators. The IHS has a vacancy rate of about 12% for health professional positions, ranging from a vacancy rate of 6% for sanitarians to 24% for dentists. Through P.L. 93-638 Self-Determination contracts, American Indian Tribes and Alaska Native corporations administer 15 hospitals, 179 health centers, 9 residential treatment centers, 117 health stations, and 180 Alaska village clinics.
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