Members of Federally recognized Indian tribes and their descendants are eligible for services provided by the Indian Health Service (IHS). The IHS is an agency of the US Public Health Service, Department of Health and Human Services. The IHS operates a comprehensive health service delivery system for approximately 1.5 million of the nation's two million American Indians and Alaska Natives. Its annual appropriation is approximately $2.2 billion. The IHS strives for maximum tribal involvement in meeting the needs of its service population. There are more than 560 Federally recognized tribes in the United States. Their members live mainly on reservations and in rural communities in 35 states, mostly in the western United States and Alaska.

Federal-Tribal Relationship
Mission, Goal, and Objectives
Health Care Delivery
Facilities Construction and Maintenance
Career Opportunities
IHS Headquarters and Area Offices

Federal-Tribal Relationship
Federally recognized Indian tribes and Alaska Native corporations enjoy a government-to-government relationship with the United States of America. This unique relationship is based on Article I, Section 8 of the United States Constitution and has been given substance through numerous Supreme Court decisions, treaties, legislation, and Executive Orders.

The provision of health services grew out of this government-to-government relationship. The IHS is the principal federal health care provider and health advocate for Indian people.

The principal legislation authorizing federal funds for health services to recognized Indian tribes is the Snyder Act of 1921. It authorized funds "...for the relief of distress and conservation of health... [and] for the employment of...physicians...for Indian tribes throughout the United States."

Congress passed the Indian Self-Determination and Education Assistance Act (Public Law 93-638, as amended) to provide tribes the option of assuming from the IHS the administration and operation of health services and programs in their communities, or to remain within the IHS direct health system. Congress consequently passed the Indian Health Care Improvement Act (Public Law 94-437) that is a health specific law that supports the options of P.L. 93-638. The goal of P.L. 94-437 is to provide the quantity and quality of health services necessary to elevate the health status of American Indians and Alaska Natives to the highest possible level and to encourage the maximum participation of tribes in the planning and management of those services.

Mission, Goal, and Objectives
The IHS provides a comprehensive health services delivery system for American Indians and Alaska Natives with opportunity for maximum tribal involvement in developing and managing programs to meet their health needs. The goal of the IHS is to raise the health status of American Indian and Alaska Native people to the highest possible level. To carry out its mission and to attain its goal, the IHS:

1. Assists Indian tribes develop their health programs through activities such as health management training, technical assistance and human resource development;
2. Facilitates and assists Indian tribes coordinate health planning, in obtaining and using health resources available through Federal, State, and local programs, and in operating comprehensive health care services in health program evaluation;
3. Provides comprehensive health care services, including hospital and ambulatory medical care, preventive and rehabilitative services, and development of community sanitation facilities; and
4. Serves as the principal Federal advocate for Indians in the health field to ensure comprehensive health services for American Indian and Alaska Native people.

Health Care Delivery
Preventive measures involving environmental, educational, and outreach activities are combined with therapeutic measures into a single national health system. Within these broad categories are special initiatives in such areas as injury control, alcoholism, diabetes, and mental health. Most IHS funds are appropriated for American Indians who live on or near reservations. Congress also has authorized programs that provide some access to care for American Indians and Alaska Natives who live in urban areas.

IHS services are provided directly and also through tribally contracted and operated health programs. Health services also include health care purchased from more than two thousand private providers. As of October 1998, the Federal system consisted of 37 hospitals, 59 health centers, 44 health stations, and 4 school health centers. Of 151 service units, 85 were operated by Tribes. In addition, 36 urban Indian health projects provide a variety of health and referral services.

The IHS clinical staff consists of approximately 840 physicians, 380 dentists, 100 physician assistants, and 2,580 nurses. IHS also employs allied health professionals, such as nutritionists, health administrators, engineers, and medical records administrators. There is approximately a 10% vacancy rate for health professional positions in the IHS.

Through P.L. 93-638 self-determination contracts, the tribal health programs also provide comprehensive preventive and curative services. As of March 1996, American Indian tribes and Alaska Native Corporations administered 12 hospitals, 116 health centers, 3 school health centers, 56 health stations, and 167 Alaska village clinics.

All 37 hospitals operated by the IHS and all 12 of the tribally-operated hospitals are accredited by the Joint Commission on Accreditation of Health Care Organizations. Of the IHS health centers, 95 percent are accredited, 87 percent of IHS health center laboratories are accredited, and 100 percent of IHS hospital laboratories are accredited.

Facilities Construction and Maintenance
Since 1960, more than 198,000 Indian homes have benefited by IHS funding of water and sewerage facilities, solid waste disposal systems, and technical assistance for operation and maintenance organizations. The age-adjusted death rate from gastrointestinal disease for American Indians and Alaska Natives has decreased by 91 percent since the sanitation facilities construction program began.

Approximately 85 percent of American Indian and Alaska Native homes have been provided sanitation facilities since the program's inception. The IHS also funds construction of new and replacement hospitals and ambulatory care facilities and staff quarters.

Career Opportunities
The IHS employs approximately 15,800 people, including members of virtually every discipline involved in providing health, social, and environmental health services. More than 62 percent of all IHS employees are of American Indian or Alaska Native descent. Individuals who have health related degrees have the option of joining the IHS as civil servants or as commissioned officers in the Public Health Service (PHS).

The PHS Commissioned Officer Student Training and Extern Program provides students of the health professions the opportunity to gain experience in a health service environment during free periods of the academic year. The Indian Health Professions program provides scholarships, loans, and summer employment in return for agreements by students to serve in the IHS, tribal, or urban Indian programs. As a matter of law and policy, the IHS gives preference to qualified American Indians in applicant selection and career development training. The PHS National Health Service Corps program offers scholarships and stipends to medical students who agree to enter primary care specialties and to sign on for a minimum two-year tour of duty in PHS programs, including IHS direct and tribal programs.

IHS Headquarters and Area Offices
IHS Headquarters is located in Rockville, Maryland. Some headquarters functions are conducted in IHS offices in Phoenix and Tucson, Arizona and in Albuquerque, New Mexico. IHS regional administrative units, called Area Offices, are located in these cities.

For more information on the Indian Health Service and its programs, contact the Communications Staff, Indian Health Service, Room 6-35, Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857. Telephone: (301) 443-3593. Fax: (301) 443-0507.