The research presented here focuses on how Indian health care is financed, how the population served by the Indian health system is measured, and whether available resources are adequate to meet the need.
Much of this work grew out of questions I encountered during my career in Tribal health. The analysis draws on federal and state administrative data, Census data, published research, and other sources to examine how the Indian health system works financially.
The Central Question
Are the resources available to Indian health programs sufficient to provide appropriate access to care?
The completed work approaches that question from several perspectives, including:
- Population and eligibility
- Indian Health Service financing
- Medicaid and Medicare
- Purchased and Referred Care
- The capacity of Tribal and other Indian health programs
Selected Research and Analysis
The material on this page is primarily a collection of completed research and analysis. It brings together papers and other work that examine different aspects of Indian health financing, access, population measurement, and program capacity.
Earlier work may be revised when new information or better methods make a substantive improvement worthwhile.
The research is presented here as a resource for understanding the financing and capacity of the Indian health system and the questions that have shaped my work over the years.
AREAS OF ANALYSIS
Over the course of my work in Tribal health, several questions have returned repeatedly.
How do we define the population served by the Indian health system?
Different measures of the American Indian and Alaska Native population can produce very different estimates of need, eligibility, and resources.
How is Indian health care financed?
Understanding the Indian health system requires looking beyond the IHS appropriation to Medicaid, Medicare, Purchased and Referred Care, and other sources of support.
Are available resources sufficient to meet the need?
Funding levels cannot be understood without considering the population served, the services required, and the capacity of Indian health programs to provide care.
What happens when the system does not have sufficient capacity?
Purchased and Referred Care, outside providers, Medicaid, and other sources of care become essential parts of the Indian health system when services cannot be provided directly.
How should we measure access to care?
Population counts, enrollment, utilization, funding, facilities, workforce, and service capacity each tell part of the story. Looking at them together provides a more useful picture of access.
These questions have informed the research and analysis presented elsewhere on this site. The Publications section provides access to selected papers and completed work.
Research Fragments..
Indian Health Finance Research Series
This volume brings together much of the research presented as individual papers in the Publications section. It examines Indian health financing, Medicaid and Medicare, and the financing of American Indian and Alaska Native health systems.
CMS–IHS Data Match Research
Research examining Medicaid enrollment among American Indian and Alaska Native populations and the relationship between CMS and IHS data is now well developed and must be funded on an annual basis to capture the valuable information that is available for research and understanding the impact of changes in Indian Health Finance.
Indian Health Policy Research
Research addressing Indian health policy, the Indian Health Service, Medicaid, Medicare, and the financing and organization of American Indian and Alaska Native health care.
Graduate Course Proposal for Training of Health Care Researchers
A graduate-level course based on the Indian Health Finance research series, including course materials and a standalone syllabus.