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Key: Original text is plain, changes are bold

Editing page Indian Health Service

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Under "Legislation" Heading:

Deleting this entire paragraph: IHS-run hospitals and clinics serve any registered Indian/Alaska Native, regardless of tribe or income. Tribal-contract health care facilities serve only their tribal members, with other qualified Indians/Alaska Natives being offered care on a space-available basis. This policy makes it difficult for an Indian who leaves their tribal home for education or employment to receive health care services to which they are legally entitled. An IHS fact sheet clarifies that Indians are also eligible to apply for low-income health care coverage provided by state and local governments, such as Medicaid. IHS 2007 third-party collections were $767 million, and estimated to be $780 million in 2008.[1]

^^The above paragraph is copied word-for-word from the book The United States Outer Executive Departments and Independent Establishments by Jock Lil Pan Chuol and is not cited, quoted or paraphrased so I will remove it.

Add to employment heading: IHS also hires Native/non-Native American interns, who are referred to as "externs". Participants are paid based on industry standards, according to their experience levels and academic training, but are instead reimbursed for tuition and fees if the externship is used for an academic practical experience requirement.[2]

Tribal Self Determination

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*Note: I created this new heading/section with subheadings* I also changed the organization, after some of Mehayla's suggestions

Important Self Determination Legislation

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In 1954, the Indian Health Transfer Act included language that recognizing tribal sovereignty and the Act additionally "afforded a degree of tribal self-determination in health policy decision-making."[3] The Indian Self Determination and Education Assistance Act (ISDEAA) allows for tribes to request self-determination contracts with the Secretaries of Interior and Health and Human Services. The tribes take over IHS activities and services through an avenue called ‘638 contracts’ through which tribes receive the IHS funds that would have been used for IHS health services and instead manage and use this money for the administration of health services outside of the IHS. [3]


- added link to wiki page on self-determination

- can you add more information about 638 contracts, that doesn't make sense for someone (aka me) reading with little backgroundWeuerle (talk) 00:27, 6 December 2019 (UTC)

Emily Note: Added info on 638 contracts after Sam's review. Also moved the sentence where he added a wiki link to be the first sentence of the next section.

Self Determination Success and Concerns

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The benefits and drawbacks of Tribal Self Determination have been widely debated. Many tribes have successfully implemented elements of health-related Self Determination. An example is the Cherokee Indian Hospital in North Carolina. This community-based hospital, funded in part by the tribe's casino revenues, is guided by four core principles: “The one who helps you from the heart,” “A state of peace and balance,” “it belongs to you” and “Like family to me” “He, she, they, are like my own family”.[4] The hospital is based on the adoption of an Alaska Native model of healthcare called the “Nuka System of Care,” a framework that focuses on patient-centered, self-determined health service delivery that heavily relies on Patient participation.

- the sentence underlined "this tribe chosse...needs" does not have encyclopedic tone, rather a research paper/persuasive writing tone, consider restructuring or omittingWeuerle (talk) 00:41, 6 December 2019 (UTC)

Emily note: omitted sentence after Sam's review

- rephrase the second underlined sentence to remove the word achieves, it is hard to distinguish whether or not that is an observation or a judgement without a sourceWeuerle (talk) 00:41, 6 December 2019 (UTC)

Emily note: edited sentence after Sam's review

The Nuka System of Care was developed by the Southcentral Foundation in 1982, a non-profit healthcare organization that is owned and comprised of Alaska Natives.[5] The Nuka System’s vision is “A Native community that enjoys physical, mental, emotional and spiritual wellness”.[5] Every Alaska Native in the health system is a “customer-owner” of the system and participates as a self-determined individual who has a say in the decision-making processes and access to an intimate, integrated, long-term care team. When a customer-owner seeks care, their primary care doctor’s foremost responsibility is to build a strong and lasting relationship with the beneficiary, and customer-owners have various options through which they can give input and participate in decisions about their health. These options include surveys, focus groups, special events and committees.[5] The board is made up entirely of Alaska Natives who helped design the system and actively participate in running it effectively.[5] Following the implementation of the Nuka System of Care in Alaska Native health, successes in improved standards of care have been achieved, such as increases in the number of Alaska Natives with a primary care provider, in childhood immunization rates, and customers satisfaction in regard to respect of culture and traditions. In addition, decreases in wait times for appointments, wait lists, emergency department and urgent care visits, and staff turnover have been reported.[5] The North Carolina Cherokee Indian Hospital in 2012 as well as other tribes have implemented the Nuka System approach when planning their new or revamped health centers and systems.

- in the first underlined sentence, I split into more digestible sentences Weuerle (talk) 00:42, 6 December 2019 (UTC)

Emily note: I agree with this edit!

- second section of underline, consider making more concise Weuerle (talk) 00:42, 6 December 2019 (UTC)

Some tribes are less optimistic about the role of Self Determination in Indian healthcare or may face barriers to success. Tribes have expressed concern that the 638 contracting and compacting could lead to “termination by appropriation,” the fear that if tribes take over the responsibility of managing healthcare programs and leave the federal government with only the job of funding these programs, then the federal government could easily “deny any further responsibility for the tribes, and cut funding”.[6] The fear of potential termination has led some tribes to refuse to participate in Self Determination contracting without a clear resolution of this issue.[7] Some tribes also renounce Self Determination and contracting because of the chronic underfunding of IHS programs. They do not see any benefit in being handed the responsibility of a “sinking ship”[6] due to the lack of a satisfactory budget for IHS services. Other tribes face various barriers to successful Self Determination. Small tribes lacking in administrative capabilities, geographically-isolated tribes with transportation and recruitment issues, and tribes with funding issues may find it much harder to contract with the IHS and begin self-determination.[7] A lack of resources and poverty can thus make Self Determination difficult.

- copy edited the last paragraph, consider trimming sentences or splitting them up into shorter sentences.Weuerle (talk) 00:42, 6 December 2019 (UTC)

Emily note: edited the last paragraph and trimmed/combined sentences

Current issues

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Life expectancy for Indians is approximately 4.5 years less than the general population of the United States (73.7 years versus 78.1 years).[8]

In 2013, the IHS experienced funding cuts of $800 million, representing a substantial percentage of its budget.[9][10] Over the past twenty years, the gap between spending on federally recognized American Indian/Alaska Natives and spending on Medicare beneficiaries has grown eightfold.[11] This inequity has a large impact on service rationing, health disparities and life expectancy, and can lead to preventive services being neglected. Other issues that have been highlighted as challenges to improving health outcomes are social inequities such as poverty and unemployment, cross-cultural communication barriers, and limited access to care.[12] 

maybe add more information (even a sentence) explaining what social inequities is. Or another add on like "social inequities, such as..."  Weuerle (talk) 00:24, 6 December 2019 (UTC)

Emily Note: added "such as poverty and unemployment," after Sam's review

Data from the 2014 National Emergency Department Inventory survey showed that only 85% of the 34 IHS respondents had continuous physician coverage.[13] Of these 34 sites only 4 sites utilized telemedicine[13] while a median of just 13% of physicians were board certified in emergency medicine.[13] The majority of IHS emergency department from the survey reported operating at or over capacity.[13] This may contribute to emergency department crowding.[citation needed] <-- Remove this last sentence, no citation found

Since its beginnings in 1955, the IHS has been criticized by those it serves and by public officials.[14][15][16][17]

Native Americans who are not of a federally-recognized tribe or who live in urban areas have trouble accessing the services of the IHS.[18]


  1. ^ "The Indian Health Service Fact Sheets". info.ihs.gov. Archived from the original on April 23, 2008. Retrieved 2017-11-01.
  2. ^ "IHS Extern Program". IHS Scholarship Program. Retrieved 2019-10-21.
  3. ^ a b Warne, Donald; Frizzell, Linda Bane (2014-06). "American Indian Health Policy: Historical Trends and Contemporary Issues". American Journal of Public Health. 104 (S3): S263–S267. doi:10.2105/AJPH.2013.301682. ISSN 0090-0036. {{cite journal}}: Check date values in: |date= (help)
  4. ^ "Cherokee Indian Hospital Authority". Retrieved 2019-12-03.
  5. ^ a b c d e Gottlieb, Katherine (2013-01-31). "The Nuka System of Care: improving health through ownership and relationships". International Journal of Circumpolar Health. 72 (1): 21118. doi:10.3402/ijch.v72i0.21118. ISSN 2242-3982.
  6. ^ a b https://www.kff.org/wp-content/uploads/2013/01/legal-and-historical-roots-of-health-care-for-american-indians-and-alaska-natives-in-the-united-states.pdf
  7. ^ a b "Office of Community Services: Division of Tribal Services: Fact Sheets". PsycEXTRA Dataset. Retrieved 2019-12-03.
  8. ^ "Quick Look". Newsroom. Retrieved 2017-11-01.
  9. ^ Gale Courey Toensing (March 27, 2013). "Sequestration Grounds Assistant Secretary for Indian Affairs". Indian Country Today. Retrieved 2013-03-28.
  10. ^ Editorial Board (March 20, 2013). "The Sequester Hits the Reservation" (Editorial). The New York Times. Retrieved 2013-03-28.
  11. ^ Malerba, Marilynn (2013-11). "The Effects of Sequestration on Indian Health". Hastings Center Report. 43 (6): 17–21. doi:10.1002/hast.229. ISSN 0093-0334. {{cite journal}}: Check date values in: |date= (help)
  12. ^ Sequist, Thomas D.; Cullen, Theresa; Acton, Kelly J. (2011-10). "Indian Health Service Innovations Have Helped Reduce Health Disparities Affecting American Indian And Alaska Native People". Health Affairs. 30 (10): 1965–1973. doi:10.1377/hlthaff.2011.0630. ISSN 0278-2715. {{cite journal}}: Check date values in: |date= (help)
  13. ^ a b c d Bernard, Kenneth; Hasegawa, Kohei; Sullivan, Ashley; Camargo, Carlos (2017). "A Profile of Indian Health Service Emergency Departments". Annals of Emergency Medicine. 69 (6): 705–710.e4. doi:10.1016/j.annemergmed.2016.11.031. PMID 28110985.
  14. ^ Fraser, Jayme. "Indian Health Service care criticized as 'genocidal' despite improvement efforts". missoulian.com. Retrieved 2017-11-01.
  15. ^ "Sickly service". The Lawton Constitution. Retrieved 2017-11-01.
  16. ^ "The Indian Health Service Paradox". Kaiser Health News. 16 September 2009. Retrieved 2017-11-01.
  17. ^ "A review of the quality of health care for American Indians and Alaska natives" (PDF). www.commonwealthfund.org. Retrieved 2017-11-01.
  18. ^ Champagne, Duane (2001). The Native North American ALmanac. Farmingtom Hills, MI: Gale Group. pp. 943–945. ISBN 0787616559.
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