Edward J. Fox, PhD
For more than three decades, I have worked at the intersection of Tribal health, health policy, research, and health financing. Since 1995, I have worked exclusively for Tribes and Tribal organizations.
When I retired in 2023, I felt confident that the leadership of state, regional, and national organizations—and their Tribal-led staff—were well equipped to carry this work forward. I was privileged to contribute to that work throughout my career.
This website is simply an attempt to capture and preserve some of that work before time takes its inevitable toll on my ability to faithfully document it. The oral tradition lives on, and many will have their own perspectives, critiques, and reflections on what is presented here. I welcome that.
My career has focused on a practical question: How can Tribal communities and the people they serve gain access to the resources needed to provide high-quality health care?
I have worked in Tribal health leadership and policy at the Tribal, regional, and national levels, including leadership roles with the National Indian Health Board, the Northwest Portland Area Indian Health Board, and several Tribal health organizations. I have also worked as a researcher, policy analyst, and technical advisor on issues involving Medicaid, Medicare, the Indian Health Service, and health care financing.
Much of my work has involved translating complicated health financing systems into information that Tribal leaders, policymakers, researchers, and health care organizations can actually use.
Why I Do This Work
Indian health financing is often discussed in terms of budgets, programs, and statistics. But behind those numbers are communities trying to provide health care with resources that do not always match the needs of the people they serve.
Over the years, I became increasingly interested in the gap between how Indian health needs are measured and how resources are actually allocated.
That led to much of the research presented on this site.
The Indian Health Finance series brings together research examining the size of the population being served, the resources available to Indian health programs, Medicaid and Medicare financing, Purchased and Referred Care, and the broader financial structure of the Indian health system.
The goal is not simply to describe the problem. It is to provide evidence that can help identify better and more effective solutions.
From Experience to Research
My perspective is shaped by having worked inside the Indian health system as well as studying it.
That experience has taught me that the most important questions are often not the easiest ones to answer.
How many people actually depend on the Indian health system?
How should the population eligible for Indian health services be counted?
How much would it cost to provide an appropriate level of care?
Where does the money come from?
Where does it fall short?
And, perhaps most importantly, what changes would make the greatest difference for the people and communities being served?
These questions have guided my research and continue to guide the work presented here.
A Continuing Project
This website is a working research archive. Some of it is recently revised from previous works.
Some of the material is drawn from research conducted over many years. Other work revisits longstanding questions using newer data and methods.
I am particularly interested in bringing together information that is often separated across federal agencies, Tribal organizations, states, academic research, and administrative data systems.
The objective is to make that information more accessible.
Beyond the Numbers
Numbers matter, but they are not the whole story.
Health financing ultimately affects whether people can obtain care, whether health programs can recruit and retain staff, whether hospitals and clinics can remain viable, and whether Tribal communities have the capacity to determine how health care is delivered.
That is why I approach this work from both a research and a practical perspective.
Good policy begins with good evidence—but good evidence is useful only when it helps people make better decisions.
About This Site
The site brings together several kinds of work:
- Indian Health Finance — research examining the financing and capacity of the Indian health system.
- Publications — papers and longer-form research.
- Graphics — visual explanations of important findings and relationships.
- Methods — information about the data, methods, and assumptions behind the research.
- Resources — selected data sources and materials useful for further research.
I hope the site is useful to Tribal leaders and health professionals, policymakers, researchers, students, and anyone interested in understanding how Indian health care is financed.
— Edward J. Fox, PhD