Cunningham P J
Center for General Health Services Intramural Research, Agency for Health Care Policy and Research, Rockville, MD.
Health Aff (Millwood). 1993 Fall;12(3):224-33. doi: 10.1377/hlthaff.12.3.224.
The Indian Health Service (IHS) is unique among U.S. private and public health programs in that free comprehensive health services are provided to eligible American Indians and Alaska Natives regardless of their ability to pay. However, resource limitations may compel some eligible persons to go outside of the IHS system to receive health care. Although IHS eligibles have comparatively low rates of private or public health care coverage, and much of this population lives in underserved areas, over half of IHS-eligible persons had some type of out-of-plan use in 1987. Furthermore, services received through private providers appear to supplement those received through IHS-sponsored providers. Overall, persons who use both IHS and non-IHS providers have higher levels of health care use than do those who rely exclusively on the IHS.
印第安卫生服务局（IHS）在美国的私立和公立卫生项目中独树一帜，它为符合条件的美国印第安人和阿拉斯加原住民提供免费的全面医疗服务，无论他们的支付能力如何。然而，资源限制可能迫使一些符合条件的人到印第安卫生服务局系统之外去接受医疗保健。尽管符合印第安卫生服务局资格的人享有私人或公共医疗保险的比例相对较低，而且这一人群中的大部分生活在医疗服务不足的地区，但在1987年，超过一半符合印第安卫生服务局资格的人有某种形式的计划外就医行为。此外，通过私人医疗服务提供者获得的服务似乎补充了通过印第安卫生服务局资助的医疗服务提供者所获得的服务。总体而言，同时使用印第安卫生服务局和非印第安卫生服务局医疗服务提供者的人比那些完全依赖印第安卫生服务局的人有更高的医疗保健利用率。
