Indian Health Service: Creating a Climate for Change

Authors: Tosatto, Robert J.; Reeves, Terrie C.; Duncan, W. Jack; Ginter, Pete M.
Source: North America Case Research Association, Case Research Journal, Fall 1999; The Laurier Institute
Year: 1999
Company Name: Indian Health Service
Number of pages: 26

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Providing comprehensive health care for more than 1.4 million American Indians and Alaska Natives, the Indian Health Service's (IHS) 15,000 plus employees were responsible for the operation of more than 500 facilities with a budget greater than $2 billion. Dr. Michael Trujillo, the IHS Director, knew that to accomplish the agency's mission the IHS had to honor numerous past treaties made between the Indian tribes and the United States. Respect for the beliefs and spiritual convictions of the various tribes was formally recognized in the Indian Self-Determination process, but despite this, the IHS was considered a discretionary agency in the Congressional budget process. It had no adequate third-party payer billing system, it faced difficulty recruiting professional staff, and it served a population whose health indicators lagged behind the rest of the United States. Dr. Trujillo had to decide how to lead the IHS through troubled times while raising the IHS population's health status, even with little likelihood of increased funding.

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