Document Type



It has been 25 years since the federal policy of Indian self-determination was first conceptualized in the form that was ultimately enacted into Public Law 93-638, the Indian Self-Determination and Education Assistance Act, in 1975. Through both self-determination contracting and self-governance compacting, tribes have options to transfer tribal shares of Area Offices and Headquarters Offices of the Indian Health Service (IHS) to local tribally-operated health programs. This project provides an assessment of the impacts of tribal control of health care delivery systems.This study explores the impacts of tribal control of health care delivery systems from a tribal perspective and gathers evidence to assess the impacts. A survey of tribes was the most critical element of this study, since it provided the tribal perspectives necessary to accomplish the goal of the study: evaluating the impacts of tribal choices in health care. This report includes a financial analysis, as well as an assessment of the changes in the services and facilities, management changes and challenges, and the impacts on quality of care.The project report is organized into four volumes. Volume 1 is the executive summary. Volume 2 is the narrative report. Volume 3 contains the supporting data. Volume 4 is a compilation of volumes 1, 2, and 3. The study also looks at the opportunities and barriers to contracting and compacting, the issue of tribal sovereignty, future trends and recommendations from tribal leaders.This study has provided the opportunity to survey a broad cross-section of tribal leaders and health directors from every Area of the IHS and every type of health care delivery system. In combination with financial analysis, the information obtained provides a quantitative and qualitative assessment of the impacts of self-determination contracting and self-governance compacting on the system of health care services for American Indians and Alaska Natives. It is significant because it offers a tribal perspective on the changes that have occurred in the past 3-4 years in which tribal self-governance demonstration projects have become part of the landscape of the health care in Indian Country.

Publication Date



National Indian Health Board, 1385 S