Document Type



On February 24, 1975, the Four State Indian Health Board contracted with the Aberdeen Office of the Indian Health Service to assess the health delivery system to Indian people in the four state area. The predominant emphasis of the project was to assess the existing contract care system with the underlying general purpose being to determine if this could not be made more effective. A specific purpose was to explore the possibility of establishing an Indian Health Service medical referral center in the Aberdeen Area as a way of increasing the cost-effectiveness of the health delivery system. This report grows out of the Medical Referral Center Evaluation Project. The report has three general objectives. First, it describes the contract health care situation for Indian People in IHS Aberdeen Area service population. Secondly, following the presentation of this information, possible alternatives for improving health care delivery are outlined and discussed. Third, the additional data and analysis required for arriving at a choice among these alternatives is detailed.An inhouse task force was appointed by the Acting Aberdeen Area Director. This task force consisted of three IHS Service Unit Directors and two IHS physicians. Their assignment was to do a feasibility study on establishing an IHS medical referral center in Rapid City, South Dakota. This report was a first step but more was needed before such a major investment could be seriously contemplated--capital costs alone for an Aberdeen Area referral center were estimated by the in-house task force at $30,000,000. Basic data for the report, e.g.. expenditures in the Aberdeen Area for given disorders, vendor lists, etc., was supplied by Aberdeen Area staff. This data was analyzed and compiled to reflect the recommendations.The Aberdeen Area was receiving only 52% of the resources needed for contractual health care. There is a need to more than double the current contract care funding and--since the cost of care is rising yearly--to develop a system whereby funds are increased automatically each year as costs rise. All service units are understaffed and have been forced to assume almost the entire burden of providing medical treatment beyond the primary care level. From a standpoint of overall Indian health care, the situation is deplorable. Service units are not meeting the basic health needs of the Indian population in the Aberdeen Area. A large part of the total service population has never had a diagnostic examination. When incidence and treatment figures are coupled with the known health situation for Indian people generally, it can be concluded that the unmet medical/surgical needs in the Aberdeen Area service population in FY 1974 were undoubtedly far more numerous that the treated cases. The Aberdeen Area service population is increasing and is expected to continue. Thus, it seems safe to that the health care needs of the future Aberdeen Area will be considerably greater than the needs of the present population. Insufficient money is the overriding problem with the IHS contract care system.Four possible alternatives will be presented for improving the health care of the Aberdeen Area service population. The four possible alternatives are: 1) increased funding for the present system; 2) upgrading service unit facilities; 3) a mini-center system; and (4) an IHS Area medical center. Any one of the four or a combination of the four would be an improvement over the present situation. In order to make a choice, consideration must be given to general information regarding capital cost data, operating cost data, benefit data, and service population desires. Attention must also be addressed to specific needs such as: obtaining staff, location, feasibility of mini-centers, preliminary planning/design, and securing funding. One last point in connection with the improvement of health care facilities in the Aberdeen Area is the development of a tentative plan to how national health insurance could be interwoven with a new approach to health care delivery.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-94).