HEALTHCARE IN THE UNITED STATES
SPECIAL POPULATIONS
Indian Health Services (IHS) works with American Indian and Alaska Native (AIAN) tribe governments to meet the complex needs of their people. Yet, only about 2.56 million are receiving comprehensive health services through the Indian Health Service organization. This in large part is because most IHS services occur in the rural tribal areas and abutting counties. A majority of AIAN’s live outside of tribal areas in urban settings (70%) and may or may not have access to urban clinics (Office of Minority Health [OMH], 2018). Geographic inaccessibility and needed services that are not available could be reasons why AIAN do not seek care in urban areas. Lack of access to adequate healthcare is a common issue for AIAN’s and results in poor health outcomes.
Figure 7.3: Child Receiving Care at an IHS Clinic
Source: Indian Health Service
Attribution: Indian Health Service
License: Public Domain
The Indian Health System is made up of direct care healthcare services, tribally operated healthcare services, and urban Indian healthcare services and resource centers. Funding is authorized by Congress annually, and IHS has received a small increase each year: $5.0 billion (b) for FY 2017, $5.5b for FY 2018, $5.8b for FY 2019, and $6.0b for FY 2020. However, IHS per user expenditure in FY2019 was only $4,078 compared to $9,726, U.S. National Health Expenditure per person in 2017 (IHS, 2020a). Clearly, more financial support is needed to increase this financial disparity and ensure American Indians and Alaska Natives have access to quality healthcare that can meet their health needs.
7.5 MILITARY VETERANS
The U.S. Armed Forces includes 1.3 million active duty, 1.1 million National Guard and Reserve, and over 20 million veterans (DMDC, 2019). Gulf War veterans—those serving from 1990 to the present—are now the largest group of veterans (Bialik, 2017). According to the U.S. Department of Veterans Association (VA) (2020a), the total veteran population is predicted to decline from 19.5 million
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