Tribal community management of health care: What are the lessons?

What happens when American Indian nations, instead of the federal government, manage on-reservation health care? This question is at the center of a multi-year research project initiated by the Native Nations Institute (NNI) at The University of Arizona.

Designed to provide American Indian nations with evidence-based information that will assist them in making sound decisions regarding health-care management strategies, this project is focused on three specific tasks: (1) developing more evidence on the core question, “Does community control lead to improved access?”; (2) using case studies to examine both the conditions under which community control is productive and those health-care management strategies that appear to be improving access; (3) producing more systematic and conclusive evidence about the impact of community control on access to health care in reservation communities.

The case study component includes 6-10 case studies focusing on how health care management strategies and access vary across different levels of community control. We have developed an interview protocol that asks how each participating tribe has approached health care management decision making. In addition, a sounding board consisting of seven Native health professionals provides NNI with feedback on study processes, analysis, and products, as well as information and knowledge from the field.

While this research is still in progress, anecdotal evidence suggests that successful community control includes strategic decision-making; good working relations with local non-Native community, tribes, and other governments; greater emphasis on spiritual dimensions of health care; and a vision shared by the staff, citizens and tribal government.