A Review of the Quality of Health Care for American Indians and Alaska Natives

The author documents health care disparities for American Indians and Alaska Natives (AIANs) and reports on progress made in the last five years to reduce or eliminate gaps in care. In examining the demographics of this group, she notes in particular a substantial urban AIAN population that is both understudied and which may be underserved by the traditional AIAN health care infrastructure. The author also reports on changes to this infrastructure, with management shifting from the Indian Health Service (IHS) to tribes and the use of more managed care—neither of which changes have been well studied. New initiatives for quality monitoring are described, including the IHS’s initiatives under the Government Performance and Results Act. The author also reviews initiatives on the treatment and control of specific medical conditions. The author offers 10 conclusions/recommendations with respect to disparities between medical care for AIANs and the general population. Support for this paper was provided by The Commonwealth Fund. The views presented here are those of the author and should not be attributed to The Commonwealth Fund or its directors, officers, or staff. Additional copies of this (#756) and other Commonwealth Fund publications are available online at www.cmwf.org. To learn about new Fund publications when they appear, visit the Fund’s website and register to receive e-mail alerts.