Minority Health

Researchers compare receipt of health care from public and private providers serving one North Carolina Indian tribe

About 60 percent of the Nation's 2.4 million American Indians are eligible to receive Indian Health Service (IHS) benefits. This leaves those who are ineligible, like the North Carolina Lumbee Indians, to seek health care from non-IHS public clinics and private physicians. Lumbees are recognized by the State but not the Federal government as American Indians and therefore are ineligible for IHS benefits. Consequently, they obtain their general health care at a single federally funded community health center or, for those who have the necessary resources, from private physicians.

A recent study that was supported in part by the Agency for Healthcare Research and Quality (HS10854) found that Lumbee Indians who usually obtain care from a public clinic physician receive similar preventive services and have comparable health (except for more frequent use of smokeless tobacco) to Lumbee Indians whose usual source of care is a private physician. Researchers led by Alfred Bryant, Jr., Ph.D., of the University of North Carolina at Pembroke, surveyed 939 Lumbee Indians about their usual source of care and health status. Of these, 80 percent had a private physician, and 18 percent had a public health clinician as their usual source of care; 2 percent reported having neither.

Receipt of flu vaccination, diabetes screening, blood pressure monitoring, prostate exam, Pap smear, and mammogram was not significantly different between the two groups. Health behaviors were similar for exercise, smoking (but not smokeless tobacco), and performing breast self-examination.

The finding of no differences in receipt of preventive services is notable, particularly because procedures such as prostate examinations and Pap smears require considerable time, the reasons cited most often for not following care guidelines. Also, use of private physicians should not be equated with insurance coverage since, like 1 million other American Indians, Lumbees have few alternatives. Since this study was conducted in a single rural tribe, results may not generalize to other American Indians or urban communities.

See "Health differences among Lumbee Indians using public and private sources of care," by Dr. Bryant, Turner Goins, Ph.D., Ronny Bell, Ph.D., and others, in the Summer 2004 Journal of Rural Health 20(3), pp. 231-236.

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