Document Type



Based upon Senate Report No. 100-165 and Conference Report No. 100-498 of FY 1988, the Committee on Appropriations requested that the Indian Health Service (IHS) conduct an assessment of the needs of urban Indians residing in the State of Arizona. The primary source of health care for urban Indians is the IHS. Other sources include county medical facilities, community health centers, and private providers. These latter resources are rarely used. More than 40 percent of the urban Indian community in Arizona utilize hospital emergency facilities. Overcrowding, transportation difficulties, and limited hours of primary health care service facilities result in the use of hospital emergency services. A current court case, Arizona vs. the United States was pending as of the publication date of this report. The results of this case will determine who is the payer of last resort. The IHS or the state Medicaid program, when urban Indians are unable to pay for costly emergency service. Many Indians are among the urban working poor and do not qualify for the state Medicaid programs. The purpose of this study is to determine 1) the present health status of the urban Indian population in the state of Arizona; 2) the extent of use and availability of all health resources (Federal, State, County, City, and Tribal); and 3) health needs and barriers to addressing those needs. It is intended that the study provide accurate and timely information that will serve as an objective base for decision making.Demographic and health care data were drawn from six cities in Arizona. The cities were Phoenix, Tucson, Yuma, Winslow, Flagstaff, and Kingman. In spite of the current difficulties in eligibility criteria, the authors of this report found it necessary to construct a working definition of 'urban Indian'. For the purposes of this study, urban Indian is defined as all self-defined/IHS direct service eligible Indian persons located in a non-reservation, urban setting. A more restrictive, tribal and residence based definition applies to Indians eligible for IHS contract care services. The researchers followed a needs assessment model that appears as: Health Status - Resources Used + Barriers = Health Needs. Health status was defined as proportional mortality. Comparisons for the health status of Arizona's urban Indian populations were made with the health status of the state's non-Indian population and national Indian and non-Indian populations. Health resources data were taken from Information & Referral Reports and Data Reports, and subjective recall in an interview format. Thus the needs assessment process occurred in two phases: 1) the investigation of existing data, and 2) a process of interviews and community assessment data analysis. Barriers to resources not used were defined as unmet economic need, institutional barriers, and subjective perspectives on the known and/or available health care service providers. Constraints against the study included: 1) time restrictions affecting the gathering of data that was not immediately available, 2) unavailable or nonexistent data on urban Indians, 3) limited coordination and planning about the urban Indian populations by federal, state, and local governments, and private agencies, 4) contradictory basic data on demographic factors, and 5) the pending litigation severely hampered the flow of information and restricted the possibility of full cooperation by state and federal agencies.The study concludes that the health care status of urban Indians is poor. The major causes of death are accidents, alcoholism, homicide, heart disease, and diabetes. These conditions create chronic morbidity problems, as well as, causing death. Mental health problems also affect the urban Indian populations. Prenatal care is most often neglected entirely, or until late in the pregnancy. Indian specific health services are limited by restricted hours, limited access for client transport, and overcrowding. Barriers to all available services include socioeconomic factors, uninsured clientele, and governmental disagreement over payment responsibilities for no-cost health care coverage. Few basic services are available for urban Indians. Overcrowding of public health care services exceeds the national average by 400 percent. There is a critical need for culturally sensitive mental health care and basic preventative, family-centered medical services. Eye clinics, dental services, health education, and drug and alcohol services are also critical to serve the needs of the urban Indian working poor.Recommendations were made under two classifications - service and policy. Service recommendations include 1) maternal and child health services. 2) ambulatory clinic facilities, 3) eye clinics, 4) preventative programs for families, 5) mental health services, and 6) women, infants, and children programs. Policy recommendations include the establishment of Medicaid education programs and coalition efforts between tribal governments, the IHS, state and local governments and private agencies. The final recommendation stressed the need to clarify and ease the responsibility of the Phoenix Indian Medical Center. The PIMC is a hospital designed for a maximum of 40,000 outpatient encounters and they currently serve over 100,000. The report suggests that dedicated and idealistic staff are necessary but not sufficient to cope with the excess burden indefinitely.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-85).