Kunitz S J
Department of Community and Preventive Medicine, University of Rochester School of Medicine, NY 14642, USA.
Am J Public Health. 1996 Oct;86(10):1464-73. doi: 10.2105/ajph.86.10.1464.
This paper traces the development of the US federal government's program to provide personal and public health services to American Indians and Alaska Natives since the 1940s. Minimal services had been provided since the mid 19th century through the Bureau of Indian Affairs of the Department of the Interior. As a result of attempts by western congressmen to weaken and destroy the bureau during the 1940s, responsibility for health services was placed with the US Public Health Service. The transfer thus created the only US national health program for civilians, providing virtually the full range of personal and public health services to a defined population at relatively low cost. Policy changes since the 1970s have led to an emphasis on self-determination that did not exist during the 1950s and 1960s. Programs administered by tribal governments tend to be more expensive than those provided by the Indian Health Service, but appropriations have not risen to meet the rising costs, nor are the appropriated funds distributed equitably among Indian Health Service regions. The result is likely to be an unequal deterioration in accessibility and quality of care.
本文追溯了自20世纪40年代以来，美国联邦政府为美国印第安人和阿拉斯加原住民提供个人和公共卫生服务项目的发展历程。自19世纪中叶起，美国内政部印第安事务局就开始提供极少的服务。由于20世纪40年代西部国会议员试图削弱并摧毁该局，卫生服务的责任被转交给了美国公共卫生服务局。此次移交因此创建了美国唯一一项面向平民的全国性卫生项目，以相对较低的成本为特定人群提供了几乎全方位的个人和公共卫生服务。自20世纪70年代以来的政策变化导致了对自决的重视，而这种重视在20世纪50年代和60年代并不存在。部落政府管理的项目往往比印第安卫生服务局提供的项目成本更高，但拨款并未随着成本的上升而增加，且拨款资金在印第安卫生服务局各地区之间的分配也不均衡。其结果可能是医疗服务的可及性和质量出现不平等的恶化。
