Indian Health Service, Health Status, and Financial Barriers to Care

Objective: To better understand financial barriers to care facing American Indian and Alaska Native households, this study builds on previous findings that these communities have a higher likelihood of having medical debt and engaging in cost avoidance. This study aims to build on those findings by controlling for health status, insurance type, and IHS eligibility. Design: This study uses data from the National Health Information Survey in binomial logistic regression models to examine the likelihood of American Indian and Alaska Native households having medical debt and engaging in cost avoidance. Results: The results of the logistic regression analysis found that while health status and IHS eligibility significantly contribute to the likelihood of having medical debt or engaging in cost avoidance, racial disparities remain for American Indian and Alaska Native communities. Conclusions: Despite access to the Indian Health Service and Tribal care, American Indian and Alaska Native households face disparities in financial barriers to care. These results suggest that, rather than the proposed cuts to the Indian Health Service, additional funding is needed to address shortcomings in the IHS/Tribal system of care in American Indian and Alaska Native communities.