Indian Health Service

The Indian Health Service (IHS) is the agency within the U.S. Department of Health and Human Services responsible, since 1955, for providing federal health services to American Indian and Alaska Native (AI/AN) people. Its charge as the principal healthcare provider and health advocate for AI/ANs is to collaborate with federal entitlement programs, state or local healthcare programs, and private insurance providers to mobilize the necessary funding and adequate healthcare provision for the AI/AN population. This includes approximately 1.8 million of the nation's estimated 3.3 million AI/ANs who belong to more than 562 federally recognized tribes. Most IHS services are designated for AI/ANs who live on or near reservations/villages located in 35 states, primarily in the western United States. However, some AI/ANs who live in urban areas are served by this agency.

The provision of health services to members of federally recognized tribes grew out of a special government-to-government relationship between the federal government and Indian tribes established in 1787. This unique relationship is based on Article I, Section 8 of the U.S. Constitution and has been given substance through numerous Supreme Court decisions, treaties, legislation, and executive orders that acknowledge the federal government's obligation to provide free health care to AI/AN people in exchange for their cessation of over 400 million acres of tribal land.

In 1975, the U.S. Congress passed the Indian Self-Determination and Education Assistance Act (Public Law 93–638) to provide tribes the option of either assuming from the IHS the administration and operation of health services and programs in their communities or remaining within the IHS direct healthcare system. Congress consequently passed the Indian Health Care Improvement Act (IHCIA; Public Law 94–437) in 1976. The IHCIA is a health-specific law that provides appropriate authority for the delivery of health services to AI/ANs and supports the options of PL. 93–638. The goal of this legislation is to provide comprehensive directives to the federal government regarding the delivery of services to AI/ANs and to encourage the maximum participation of tribes in the planning and management of those services.

The stated mission of the IHS, in partnership with AI/AN people, is to raise their physical, mental, social, and spiritual health through comprehensive and culturally acceptable personal and public health services. To that end, it assists tribes in developing their health programs through activities such as health management training, technical assistance, and human resource development. It provides hospital and ambulatory medical care and preventive and rehabilitative services. The agency also helps develop community sanitation facilities for Indian homes that have neither a safe water supply nor an adequate sewage system. Preventive measures involving environmental, educational, and outreach activities are combined with therapeutic measures. Within these broad categories are special initiatives in areas such as injury control, alcoholism, diabetes, and mental health.

The operation of IHS programs is overseen by 12 regional administrative units called area offices. Each area office provides administrative support in the forms of distributing funds, monitoring programs, evaluating activities, and providing technical support to the hospitals, clinics, and other facilities within its region. IHS-funded services are delivered through three mechanisms: direct IHS services, tribal services, and Urban Indian Health Programs. These services are provided to those qualified AN/ANs who meet IHS eligibility criteria. For those qualifying, health services are delivered directly at IHS facilities, through tribally contracted and operated health programs or at IHS contract health service facilities. The federal system consists of 49 hospitals in 12 states, 180 health centers in 12 states, 273 health stations in 18 states, and 8 school health centers. In addition, 34 Urban Indian Health Programs provide limited health and referral services to approximately 150,000 AI/ANs living in cities throughout the country.

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