Purpose The focus of the Roundtable Conference was the reauthorization of the Indian Health Care Improvement Act (IHCIA), Public Law 94-437. The purpose of this Roundtable Conference was to stimulate discussion and recommendations regarding the Indian Health Care Improvement Act (IHCIA) that would result in a base of information from which the Indian Health Service (IHS) will begin to plan a tribal consultation process. The expiration of the IHCIA in fiscal year 2000 is of great concern to the participants of this roundtable discussion. Methods This Roundtable brought together approximately 25 participants from the field of Indian health care delivery and program services. Each participant brought extensive background and expertise in the Indian health care field as tribal leaders, health care providers, public health administrators, urban program directors, and Congressional technical advisors. The participants were asked to: 1) think globally and futuristically about the national health care environment as it is currently evolving; 2) identify environmental influences and changes in the health care industry and the impact on IHS, tribal and urban (ITU) systems; 3) identify opportunities for change in the reauthorization process; 4) envision how "Indian Country" will work with U.S. congressional committees; 5) identify key issues and goals of the new legislation; 6) provide guidance on the IHS/tribal consultation process; 7) discuss emerging trends such as managed care; and 8) be solution oriented. Results The results of this discussion will assist the IHS and local tribal and urban health officials define the many issues involved in the pending reauthorization; changes in health care environment affecting Indian health today; and an analysis of the opportunities presented through the passage of comprehensive health care legislation. The roundtable participants identified health care issues in two major areas. Each of these major areas was reviewed in detail by subgroups of the roundtable participants. The two groups are: 1) Patient Bill of Rights for Indian People and 2) Changing Health Care Environment. Conclusion Recommendations focus on: 1) the National political process and environment and its effect on Indian health; 2) refocus IHCIA on prevention and a meeting the needs of the patient base; 3) public health infrastructure; 4) community ownership of health care delivery systems; 5) urban programs; 6) managed care; 7) health care partnerships - federal, state, tribal governments and the ITUs; 8) psychosocial and behavioral health; 9) tribal self-determination and self-governance; 10 ) cost factors; 11) facilities; 12) health care manpower; 13) billing, reimbursement and financing; 14) health care accessibility; 15) data and technology; 16) long-tem health care.
Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857.
Reauthorization of the Indian Health Care Improvement Act P.L. 94-437. Speaking with one voice, IHS, tribes, urban. Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857. 1998