Indian Health Financing | Graduate Course
Understanding Indian Health Financing
How is health care for American Indians and Alaska Natives financed—and what
does the evidence tell us about resources, need, and policy?
This course provides a guided introduction to the financing system. Rather
than treating Indian Health Service funding as a single budget, it follows
the major financing streams, examines the evidence, and considers what the
findings mean for Indian health policy.
The Course
Why Is Indian Health Financing Different?
An introduction to the distinctive financing structure and why the IHS
appropriation is not the same thing as total Indian health financing.
Where Does the Money Actually Come From?
Follow federal appropriations, Medicaid, Medicare, PRC, Tribal resources,
and other financing streams through the health system.
What Does IHS Finance?
Examine direct care, Purchased/Referred Care, facilities, public health,
active users, and the relationship between financing and need.
How Does Medicaid Fit Into Indian Health?
Explore enrollment, utilization, reimbursement, provider participation,
and Medicaid’s distinctive role in Indian health financing.
What Happens When Coverage Overlaps?
Examine Medicare, Medicaid, dual eligibility, and the challenge of measuring
multiple financing streams around the same patient.
Is Indian Health Adequately Financed?
Move from describing financing to evaluating resources, population, utilization,
unmet need, and alternative measures of adequacy.
How Do We Measure Indian Health Financing?
Learn how population, enrollment, utilization, and spending measures differ,
and why definitions and denominators matter.
What Should We Do With the Findings?
Bring the financing and data analysis together and consider what the evidence
can contribute to Tribal, federal, and health policy decisions.
What You Will Learn
- Identify the major sources of Indian health financing.
- Distinguish IHS appropriations from broader health-care financing.
- Explain the roles of Medicaid, Medicare, and Purchased/Referred Care.
- Understand dual eligibility and overlapping financing streams.
- Evaluate population, enrollment, utilization, and spending measures.
- Recognize important data and methodological limitations.
- Connect financing evidence to Indian health policy.
A guided path:
Start with the financing system → follow the money → understand IHS →
examine Medicaid and Medicare → test adequacy → work with the data →
apply the evidence to policy.
Research & Further Study
The course is designed to lead into the papers, graphics, data sources,
and other Indian Health Finance research presented elsewhere on this website.
Those materials provide opportunities to go beyond the introductory lessons
and examine the evidence in greater depth.
The course is intended as a framework for study and research. Individual
segments can be used independently, but the sequence provides the clearest
introduction to the financing system.
Edward J. Fox, PhD 