The Past and Future of the Indian Health Service, Case Study Example

Introduction

This case study is about the past and future of the Indian Health Service. In particular, although Native Americans as a result of a treaty with the federal government, receive health care from the Indian Health Service, both the numerous Indian tribes and the IHS are facing severe problems. Foremost, this case is how both will deal with change.

The Indian Population

The Indian population, composed of over 500 tribes, will face a number of looming structural and special changes. Overall, the IHS is responsible for the health of over 1.45 million Native Americans (Capper et al., 2001). Over the past 20 years, the Indian population has mirrored many of the problems in the general population for health. The disease burden is shifting from one-off acute conditions to more chronic conditions that require more health resources expended over a longer time period. According to Exhibit 7-10, there is a mixture of acute and chronic conditions that make up for death and hospitalization visits (Capper et al., 2001). On top of these concerns, due to historical and other reasons, Native American tribes have dealt with issues related to substance abuse including alcohol and drugs. While there is definitely a social dimension to these issues, they also have a cost: many of the disorders listed in both hospitalization and death have a direct connection to substance abuse. Finally, the Indian population is also growing older: Although the life expectancy of American Indians is still less than that of other Americans, there is potential there for not only an extension in life, but also for more productivity until the end of life (Capper et al., 2001).

Indian Health Service

The Indian Health Service was created to help provide health care services to Native Americans; however, it only serves as one organization, albeit a crucial one. In addition to the IHS, there are also other organizations administered by tribal authorities including tribal health organizations and outside organizations that offer outreach to Native Americans in urban areas, Overall, the IHS arguably plays the most important (if not the most coordinated) role in providing preventive services and health care to the Indians. Much like the Indian population, however, the IHS is facing severe challenges. The IHS budget, which is part of the discretionary budgetary process, often times is cut or does not receive full funding; at the same time, even when it does there is evidence that it is not managed properly and the object of unduly political influence.

Besides financial management problems, the organization also has internal problems. Due to the agency’s mandate, it boasts an internal workforce of 15,000, a massive amount for any organization. The organization, however, suffers from a number of problems in human resources that includes an unruly workforce and the inability to manage the workforce efficiently over space and time. Indeed, in addition to the IHS headquarters based in Washington, D.C., the organization also has a number of offices located throughout the country, in roughly 15 states (Capper et al., 2001). This mammoth organization will need to undergo change in order to keep up with the changes in the population it serves.

Suggestions

The IHS is an organization in need of change. From the organizational dynamics to the services and way the organization is financed, there will need to be a change directive in order to ensure that it is able to provide the services it needs down the road.

The first major issue is financing for the IHS; without a plan to stabilize the organization’s finances, all other change initiatives will not likely work. That will entail a number of proposals. First, the HIS needs to petition (or have Congress do so) to establish regular budget funding that will cover the agency’s basic expenses. There may be a need to have a formula where any additional funding requests by the IHS is part of a discretionary budget process, but the basics of the organization should be funded. Second, the IHS needs to form closer bonds with the state governments and other financing sources in order to communicate the need to integrate existing offerings in a closer manner. Indeed, while Medicaid resources (either via block grant or direct funding) can help individuals in the Indian population not on the reservation, there must be a channel of corporation in which to proceed. The ability to right the organization’s finances will be a key first step in solving the other problems.

The second main change is in the types of services and how services are provided to the Indian community (both on and off the reservation). Currently, there is an overemphasis on treating conditions without an adequate emphasis on prevention of conditions. This is particularly true of many of the substance-abuse related disorders that not only rob the community of productive citizens, but also spend medical resources in a less than optimal way. The emphasis should change through a reallocation of funding that would put preventive services as the first line of defense in community (HHS, 2003). It should also be noted that preventive services need not only be clinical services: indeed, a lot of preventive services that might be of use in this case would leverage off of existing social services that helps to deal with substance abuse, domestic abuse, and other medical conditions that are strongly linked to human behavior. Thus, I would put more funds to those types of services cutting back on (or acquiring more funding) for the hospital-based services that are expensive to administer and do not necessarily solve the problem over the long-run (HHS, 2003).

Finally, the HIS itself, after focusing on financing and the services offered, must also undergo reforms. The organization in its current form is likely too big; that is, not only are there an excessive amount of employees many of which do not contribute to the mission of organization, but the number of offices outside of DC are also too many. There should be an effort to cut individuals and departments and to form “regional” centers for HIS services rather than the current organizational formation that has erected many offices without necessarily greater benefit.

Conclusion

Overall, the HIS provides a valuable service to its beneficiaries. The problem is: the population it is serving and the organization it is serving needs to change to meet new challenges.

Sources:

Capper et al. (2001). Public Health Leadership and Management: Cases and Context. SAGE.

IHS Budget. Health and Human Services. Available at: www.hhs.gov/about/…/fy_2012_budget_justification_revised.pdf