Document Type



The Indian Health Service (IHS) convened a Roundtable of experts in Indian health, community development, health research and tribal leaders to address National Health Reform and its impact on Indian health care. The Roundtable participants received an overview of major health reform proposals, and developed detailed consensus statement recommendations around the following major categories: 1) moral and legal obligation of the Federal government to elevate Indian health to the highest possible level; 2) quality of care; 3) acceptance and cultural appropriateness; 4) access and equity; 5) financing mechanisms; and 6) organization/structure of Indian health care. Analysis of health care reform and its impact on Indian health must be done in the context of the unique relationship that exists between the United States government and Indian tribes and their members. The creation of a national health plan does not relieve the Federal Government from its responsibility to elevate Indian health status to the highest possible level. The goals of health care reform, to reduce cost; provide universal coverage of a standardized benefits package; and ensure consumer choice, are consistent with the concerns of the IHS and Indian communities. Rising costs in health care have had a devastating impact on IHS Contract Health Services, and eliminated the IHS ability to implement newly authorized services. Local control and consumer choice is fundamental to the movement toward tribal contracting of health management and urban health centers. Building upon the existing framework is recommended.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (RT-10).