Document Type



In light of increases in Indian Health Service (IHS) staffing and other health services, the Northwest Portland Area Indian Health Board initiated a reassessment of the impact, necessity, and sufficiency of contracting with county Health departments. This study followed five main objectives: 1) to examine carefully the services to Indians being provided by each county health department with whom IHS currently has a valid contract; 2) to describe what may be the strengths and weaknesses in contracting with county health departments; 3) to provide cost-effective information upon which the Portland Area Indian Health Board could jointly base any decisions regarding continuance or modification of existing county health department services to Indians; 4) to provide an updated report to the Northwest Portland Area Indian Health Board, the Portland Area Indian Health Service and the Tribes concerned, regarding the current status of county services to Indians; and 6) to provide opportunity for county health department personnel, Indian health field staff, and Indian consumers to exchange views regarding central health issues. Another important objective for the project was to obtain Indian consumer response to county services. Data analysis and field evaluation meetings provided the basis for this study. Baseline data were secured from statistical and narrative contract reports from local health departments to IHS, including: 1) contract files; 2) Community Health Activities Report by county; 3) Environmental Health Daily Activity Reports by county; 4) responses to a letter to county health officers requesting lists of services provided to all residents; 5) services provided to Indians; 6) services directly attributable to IHS contracts; and 7) program plans and budgets as available. Field evaluation meetings were held with providers and consumers in the 14 health districts on planning, communications, services, program, and budget. The evaluation was based on the following criteria: 1) Health Board and Service Unit recommendations concerning the contract; 2) acceptance of county Public health services by the Indian consumers; 3) value of services based on IHS staffing equivalents; and 4) cost of services as reported by county health officers. The approach used in the report was quantitative as well as qualitative and has implications for developmental policy analysis. Seven county health department contracts in Washington, and one in north-central Idaho were found to be cost-effective when compared to the expense of providing IHS employees for the same number of hours of service. Six of the contracts in Washington were found to cost more than would direct services assuming IHS had the positions and the personnel to fill them. An arrangement was made for individualizing county contracts based on Service Unit priorities and the capabilities of the particular health department. However, the study found that Area and Service Unit level administration of the contracts would require more time and money than is currently being expended. In every case, the Indian population reported was larger than that noted on the contract. Since the contract award amount is currently based on the Indian population, to update the census figures would result in an increased award in most cases. The list of services to be provided, according to the contract, rarely describes the programs currently being offered by counties. Moreover, different program emphases are requested according to Service Unit program plans. A further study of alternatives for providing environmental health services is recommended, pending the outcome of legal determinations about the status of Tribes under P.L. 280, and proposed Environmental Protection Agency regulations. It is recommended that meetings between county health departments and Tribal or Service Unit Indian health boards, continue to be a regular and important component of every program planning and contract evaluation session.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-66).