Khetpal Vishal, Roosevelt James, Adashi Eli Y
Department of Internal Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, USA.
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
Prev Med Rep. 2021 Dec 16;25:101669. doi: 10.1016/j.pmedr.2021.101669. eCollection 2022 Feb.
The (IHS) is but the latest effort to honor the constitutional and treaty commitment made to deliver health care to American Indians and Alaska Natives in the United States. The agency currently serves over 2.5 million American Indians and Alaska Natives through IHS-operated health facilities, as well provides funding support for contractual delivery of health services by Tribes to their constituents. Not unlike its predecessors, however, the IHS is struggling to fulfill its stated mission. Access to specialty care remains limited through the agency, particularly for Urban Indians, due to limited fiscal support of the Purchase-Referred Care Program. As a result of chronic underfunding stemming from Congressional inaction, the agency faces perennial understaffing and leadership turnover. In addition, the IHS is structurally unprepared to address the progressive urbanization of Alaska Natives and American Indians, more of whom now live in New York City than in North Dakota. Given these challenges, a renewed approach is warranted. In this essay, we review the history of the IHS, examine its current fiscal challenges, outline the ongoing demographic shift of AI/AN toward urban centers, and call for the creation of a Federal Indian Health Insurance Plan. Offered as a benefit to all American Indians and Alaska Natives without cost-sharing, the plan would be applicable both on and off tribal lands. Funded through mandatory appropriations, the plan would significantly increase fiscal support for AI/AN health programs and work to reduce health disparities affecting AI/ANs in the United States.
印第安卫生服务局（IHS）不过是为履行美国对美国印第安人和阿拉斯加原住民提供医疗保健的宪法和条约承诺所做的最新努力。该机构目前通过由印第安卫生服务局运营的医疗机构为超过250万美国印第安人和阿拉斯加原住民提供服务，并为部落向其选民提供医疗服务的合同交付提供资金支持。然而，与它的前身并无不同，印第安卫生服务局正在努力履行其既定使命。由于购买转诊护理计划的财政支持有限，通过该机构获得专科护理的机会仍然有限，尤其是对城市印第安人而言。由于国会不作为导致长期资金不足，该机构面临长期人员短缺和领导层更替问题。此外，印第安卫生服务局在结构上没有做好应对阿拉斯加原住民和美国印第安人日益城市化的准备，现在居住在纽约市的这两类人群比居住在北达科他州的还要多。鉴于这些挑战，需要一种新的方法。在本文中，我们回顾了印第安卫生服务局的历史，审视了其当前的财政挑战，概述了美国印第安人和阿拉斯加原住民向城市中心持续的人口结构转变，并呼吁创建一项联邦印第安人健康保险计划。该计划将作为一项福利提供给所有美国印第安人和阿拉斯加原住民，无需分担费用，在部落土地内外均适用。该计划通过强制性拨款提供资金，将大幅增加对美国印第安人和阿拉斯加原住民健康项目的财政支持，并努力减少影响美国印第安人和阿拉斯加原住民的健康差距。
