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FY 2007 Budget in BriefIndian Health ServiceOn this page:
The Indian Health Service raises the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. The FY 2007 budget request is $4.0 billion, a net increase of $124 million over FY 2006. Additional Indian Health Service (IHS) funding is targeted towards offsetting the increased cost of providing health care, continuing to serve a growing population of eligible Indian people, and expanding health care capacity in locations where it is most needed. In partnership with Tribes, IHS is transforming its health care system through its health promotion and disease prevention initiatives and the expanded use of health information technology. Agency DescriptionAs part of the Federal government’s special relationship with Tribal governments, IHS provides health care to members of more than 560 Federally recognized Tribes. An estimated 1.9 million American Indians and Alaska Natives will be eligible for IHS services in 2007, an increase of 1.6 percent over 2006 and 11.3 percent over 2001. Care is provided directly in 48 hospitals, 272 health centers, and nearly 300 health stations and Alaska village clinics. Health facilities are located where there are concentrations of eligible Indian people – the Southwest, Oklahoma, the Northern Plains, and Alaska. IHS also contracts with hospitals and health care providers to purchase health care that it cannot provide economically through its own network. Recognizing that health prevention and disease promotion are critical to improving the health of Indian communities, IHS also builds sanitation systems to provide water and waste disposal for Indian homes, provides diabetes prevention and disease management grants to over 300 Tribes, and supports a system of behavioral health care (mental health services, alcohol and substance abuse prevention and treatment) in Indian communities.
Continuing to Serve a Growing PopulationThe challenge for IHS is to continue to improve the health of Tribal members as the population increases, the cost of providing health care rises, and chronic disease becomes increasingly prevalent in Indian communities. To meet this challenge, the budget requests additional funds for health care cost increases and population growth. Similar increases were proposed for the IHS and provided by the Congress in FY 2006. Population and the Cost of Providing Care: The budget includes new funds to serve the additional 30,000 people who are expected to seek care in FY 2007, meet the rising cost of providing services, and cover increased pay cost for the Federal and Tribal employees who provide these services. Based on past experience, these funds will allow IHS to provide a variety of additional services including 76,000 additional outpatient visits in IHS and Tribally operated facilities, 16,000 additional outpatient visits purchased from outside the IHS system, and 17,000 additional public health nursing visits. Tribally operated programs will receive these funds on the same basis as the programs IHS operates directly. Opening New Health Facilities: Additional FY 2007 funds are included to staff new outpatient facilities in Clinton, OK; Red Mesa, AZ; Sisseton, SD; and St. Paul, AK. A FY 2006 PART review found that IHS was effective in placing new health care facilities in areas where they were most needed. When fully operational, these four facilities will increase the number of primary care provider visits that can be provided at these sites by 81 percent and allow the provision of new services – 24 hour emergency room, optometry, physical therapy, and audiology. IHS has opened 14 new health facilities since 2001, including these four sites. Special Diabetes Program for Indians: Diabetes is the third leading cause of death among IHS’s service population with a mortality rate triple the rate for all Americans. To control this disease, IHS provides grants to over 300 Tribes and Indian organizations. In FY 2007, $150 million will be awarded – $700 million in total over the last five years – to support diabetes prevention and disease management at the local level. By providing additional resources, and developing and using best practice models to ensure that these funds are used effectively, IHS has increased the percentage of its patients maintaining ideal blood sugar control from 30 percent in 2002 to 36 percent in 2005. Health Insurance Reimbursements: In FY 2007, IHS expects to receive a total of $678 million in health insurance reimbursements for providing care to people covered by Medicare, Medicaid, or private health insurance. IHS facilities receive Medicare and Medicaid under a costbased methodology developed in close cooperation with the Centers for Medicare & Medicaid Services (CMS). Health insurance can make up 50 percent of the operating budget of an IHS health facility, supporting additional medical staff, equipment, and building improvements. The CMS, IHS, and the Social Security Administration are working together with CMS's Tribal Technical Advisory Group – comprised of Tribal leaders – to implement the Medicare prescription drug coverage benefit in Indian Country. Individuals employed by IHS and Tribes have been trained to provide face-to-face beneficiary consultation. These individuals understand the local Indian communities, are culturally competent, and can often speak the local Tribal language. Urban Indian Health Program: IHS’s FY 2007 budget targets additional funding for the provision of health care on or near reservations but does not include funds for the continuation of the Urban Health program. Unlike Indian people living in isolated rural areas, urban Indians can receive health care through a wide variety of Federal, State, and local providers. One health care provider available to lowincome urban Americans is the Health Resources and Services Administration’s Health Centers program which served 7.3 million urban patients, and 125,000 Native Americans, in 2004. The budget requests $2.0 billion for Health Centers in FY 2007, sufficient to serve 8.8 million urban patients and 150,000 Native Americans. Construction: The budget includes a total of $94 million for Sanitation Construction. By providing water and waste disposal systems to 300,000 Indian homes since 1960, this program has played a key role in decreasing the rates of infant mortality, gastroenteritis, and other environmentally related diseases. The budget also includes a total of $18 million for Health Facility Construction. Funds will be used to finish a new outpatient facility in Komatke, AZ, which received initial construction funding in FY 2006. When complete, this facility will provide basic ambulatory health care services – dental care, eye care, digital imaging, OB/GYN, laboratory services – and relieve overcrowding in the Phoenix Indian Medical Center. Consistent throughout HHS, requests for facilities funding focus on maintaining existing facilities but not for new construction projects. Improving Service DeliveryIHS works continually to improve efficiency in order to raise the health of Tribal members to the highest possible level. The additional resources requested for health care cost increases and population growth will allow the development of more effective strategies to improve Indian health. These strategies include the Directors’ health initiatives and improvements in health care quality through the use of health information technology. Health Initiatives: IHS is working on three interrelated health initiatives– behavioral health, health promotion/disease prevention, and chronic disease management–to help achieve significant improvements in the health of Indian communities. By providing additional funds for population growth and the rising cost of health care, the budget allows IHS and Tribal health programs to focus on these initiatives at the local level.
Improving Health Care Through Information Technology: Secretary Leavitt has said, "The use of electronic health records and other information technology will transform our health care system by reducing medical errors, minimizing paperwork hassles, lowering costs and improving quality of care." IHS has long been a leader in this area, launching its Resource and Patient Management System (RPMS) in collaboration with the Veterans Administration in 1984. In November of 2005, IHS’s Clinical Reporting System, an RPMS application, received an award from the Healthcare Information Management System Society, a healthcare industry organization that provides leadership for the optimal use of health care information technology (IT). RPMS received a score of Effective in an FY 2005 PART review and has recently been selected for use by NASA as the health management system that best met its needs. Another important example of IHS IT innovation is the Electronic Health Record (EHR), which provides a full range of services including medical records management, patient scheduling, data quality control, medical consultations, and reports for practitioners and patients. The EHR system will also have a clinical case management capability for five diseases prevalent in Indian communities – diabetes, cardiovascular disease, asthma, HIV, and obesity. The EHR is presently in use at 24 IHS and Tribal facilities with high user satisfaction and positive effects on patient care reported. The EHR should be available in all IHS sites by 2008. The budget includes an increase of $11 million for IHS implementation of the Department’s Unified Financial Management System (UFMS). In addition to supporting an integrated Department-wide financial management system, UFMS will allow IHS health care facilities to operate in a more business-like manner and improve their collection of health insurance. Indian Self-DeterminationTribes currently operate one-third of IHS's hospitals, 84 percent of its ambulatory health facilities, and 85 percent of the funds for local behavioral health programs. To enable Tribes to develop the administrative infrastructure critical for successful management of these programs, the budget includes a total of $270 million for contract support costs. Self-determination works because it is based on the principle that having health services planned and delivered at the local level is the best way of ensuring that high quality health care is delivered. This planning begins with Tribal input and consultation which is central to the way IHS operates at the local, Area and National level. The Federal Government also has a unique legal and political relationship with Tribes. As part of this special relationship, an HHS-wide budget consultation session is held annually to give Tribal leaders the opportunity to consult with HHS on budgetary issues which concern them. IHS has increased the proportion of its diabetic patients who maintain ideal blood sugar control from 30 percent in 2002 to 36 percent in 2005. IHS's 2007 target is to keep the portion of its diabetics with ideal blood sugar control at 36 percent and to increase this portion to 40 percent by 2010. This increase is important. NIH-supported clinical trials have found that an improvement in blood sugar control from poor to ideal results in a 42 percent decrease in total mortality for people with diabetes. |
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Last revised: February 20, 2006
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