Healthcare Access for Native Americans: Barriers and Solutions
This paper examines Native Americans as one of the most underserved populations in American healthcare. It explores the structural limitations of the Indian Health Service (IHS), including chronic underfunding and restricted eligibility based on federal tribal recognition. The paper highlights the particular challenges facing the 60% of Native Americans who live in urban areas, where IHS facilities are largely unavailable. It then presents several policy recommendations: increasing the number of Native American physicians, expanding IHS funding, extending outreach through mobile clinics, enabling tribal self-governance over healthcare delivery, and prioritizing preventative care—especially maternal and prenatal health—as a long-term strategy for improving community health outcomes.
- Introduction: Native Americans as an Underserved Population: Establishes Native Americans' disproportionate healthcare burdens and uninsurance rates
- Structural Limitations of the Indian Health Service: Analyzes IHS underfunding, eligibility gaps, and geographic reach
- Urban Native Americans and Health Outcomes: Documents poor outcomes for urban Native Americans lacking IHS access
- Recommendations for Improving Access and Care: Four policy solutions including physicians, funding, and preventative care
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What makes this paper effective
- It grounds policy critique in concrete data, citing specific figures such as IHS underfunding amounts and the proportion of Native Americans living in urban areas.
- It moves logically from problem identification (structural barriers) to consequence (poor health outcomes) to actionable recommendations, giving the argument a clear arc.
- It draws on a range of source types—public health journals, ACOG committee opinions, and professional association news—to support claims from multiple angles.
Key academic technique demonstrated
The paper uses a problem-solution structure reinforced by cited evidence at each stage. Rather than merely cataloguing disparities, it connects each barrier (underfunding, geographic inaccessibility, lack of physicians) to a corresponding remedy, showing how evidence-based argument leads directly to policy recommendation.
Structure breakdown
The paper opens by establishing why Native Americans are particularly underserved, then narrows to the structural role and limitations of the IHS. It pivots to the distinct challenges of urban populations before concluding with four concrete recommendations: training more Native American physicians, increasing IHS funding, enabling tribal contracting, and investing in preventative and maternal care.
Introduction: Native Americans as an Underserved Population
One of the most underserved populations in America with respect to healthcare is Native Americans. This community carries a higher burden of illness, injury, and premature death, yet the healthcare needs of this population are seldom part of policy discussions, partly because of its relatively small size (Katz, 2004). More Native Americans are uninsured than most other groups, which creates serious problems with respect to access to care. Katz (2004) notes that almost half of low-income Native Americans were uninsured prior to the Affordable Care Act, and that over half of this group has incomes more than 200% below the poverty line, meaning the impact of limited access is widespread.
Structural Limitations of the Indian Health Service
At the structural level, the U.S. government has responsibility for providing healthcare to members of federally recognized tribes, a function carried out by the Indian Health Service (IHS). The IHS is known to be chronically underfunded—by approximately $1.8 billion as of 2004. Moreover, the IHS has limited reach (Katz, 2004). It serves only around 1.5 million of the 4.1 million people identified as Native American. The remainder are ineligible for IHS care because they are not members of federally recognized tribes. Many others live far from IHS facilities, which are concentrated in areas with high Native American populations; these services are largely unavailable outside those areas.
Katz (2004) notes that when the IHS was created, the majority of Native Americans lived on reservations, but today a large percentage of the Native American population lives in urban areas. This demographic shift has rendered the original geographic logic of the IHS largely obsolete.
Urban Native Americans and Health Outcomes
With 60% of Native Americans now living in urban areas, they are either ineligible for IHS care or lack access to IHS facilities (ACOG, 2012). Health outcomes for this community in urban settings tend to be poor, including higher rates of teenage pregnancy, late or absent prenatal care, alcohol and tobacco use during pregnancy, higher infant mortality, higher rates of sudden infant death syndrome (SIDS), and higher rates of preterm birth. These outcomes reflect the consequences of inadequate access to care for urban Native American women (ACOG, 2012).
References
ACOG (2012). Health care for urban American Indian and Alaska Native women. The American College of Obstetricians and Gynecologists. Vol. 515 (Jan 2012).
Allison, M., Rivers, P., & Fottler, M. (2007). Future public health delivery models for Native American tribes. Public Health, 121(4), 296–307.
Katz, R. (2004). Addressing the health care needs of American Indians and Alaska Natives. American Journal of Public Health, 94(1), 13–14.
Komaromy, M., Grumbach, K., Drake, M., Vranzian, K., Lurie, N., Keane, D., & Bindman, A. (1996). The role of Black and Hispanic physicians in providing health care for underserved populations. New England Journal of Medicine, 334, 1305–1310.
Marcinko, T. (2016). More Native American doctors needed to reduce health disparities in their communities. AAMC News. Retrieved November 27, 2017, from https://news.aamc.org/diversity/article/native-american-health-disparities/
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