These individuals will then be able to seek some aspects of care and reimbursement through these qualifying federal services, and allow the IHS to bill federal programs to offset its own billing costs and to ensure the elimination of redundancy. These programs supplement the provision of care for American Indians and Alaska Natives and reduce the funding burden on limited funds directed to the IHS. These federal programs, also assist those who qualify in receiving care in areas where IHS services are not traditionally located, off reservation and possibly even in urban and/or rural areas without IHS services and programs. Stakeholders in the programs are of course the IHS itself, all those American Indians and Native Alaskans who are covered by its services or could be covered for services, and the 557 Indian Nations in the 35 states they are affiliated with. Secondary shareholders are all the supplemental federal agencies including the U.S. Department of Health and Human Services, Medicare programs and various state Medicaid programs that provide supplemental care and are then eligible for match funds from the IHS funding structure. The IHS as a stakeholder is affected by the program as it receives almost exclusive federal funding for the services it provides, which in many ways serve as outreach to the native populations under it care. The American Indians and Native Alaskans are affected by the service in that it is their primary mode of medical care, within a system that is closer to universal health care than any other provided by the federal government. The Individuals and their tribes also seek and receive funding to provide outreach for awareness activities associated with the development of prevention and chronic illness risk training and identification for native peoples. These especially high risk issues include but are not limited...

(Coward, Davis, Gold, Smiciklas-Wright, Thorndyke, & Vondracek, 2006, p. 172) (French, 2000) Additionally the natives themselves often receive preferential hiring in IHS clinics and programs, which are tribal run, offering a significant source of well paid employment for natives, often in their own communities, an area where traditional sustainable employment is often lacking. Tribal run clinics and programs affect tribes in that they provide not only legitimate and sustainable employment for members but also help them develop their own independent infrastructures and programs, allowing a significant source of social and physical development in frequently impoverished and underserved areas. (Million, 2000, p. 101) Federal health provision organizations as a final stakeholder in the IHS, are affected in that they are then capable of providing services to native qualifiers and offsetting 100% of the cost to provide such care to the IHS funding structure, which then allows them to provide more services to the general public without a funding burden.
References

About IHS (2008) Retrieved December 5, 2008 http://www.ihs.gov/PublicInfo/PublicAffairs/Welcome_Info/IHSintro.asp

Coward, R.T., Davis, L.A., Gold, C.H., Smiciklas-Wright, H., Thorndyke, L.E., & Vondracek, F.W. (Eds.). (2006). Rural Women's Health: Mental, Behavioral, and Physical Issues. New York: Springer.

French, L.A. (2000). Addictions and Native Americans. Westport, CT: Praeger Publishers.

IHS homepage (2008) Retrieved December 5, 2008 http://www.ihs.gov/index.asp

Million, D. (2000). Policing the Rez: Keeping No Peace in Indian Country. Social Justice, 27(3), 101.