No stone unturned: American Indians Accessing Health Care

Background: One of the biggest health disparities for American Indians (AI) is the delay of accessing care. In cancer, many who are diagnosed early (Stage 1), may progress to Stage 2 or beyond before they access care. Much delay is due to health care organizational factors determining services available and not available on reservations and urban areas. AIs may not be aware of how to access care and assume care is readily available. Unfortunately, new health problem leave many AIs struggling to access timely care.

Method: Focus groups were held in four regions including two urban (Los Angeles, Denver) and rural areas (Michigan and North Dakota). Focus groups were analyzed by two independent coders and reviewed by the research team.

Results: AIs traveled great distances for services, many going between cities and reservations, hundreds of miles apart. Many state employees did not have accurate information about Indian Health Service (IHS) limits and participants found explaining this difficult. Such poor communication led to delayed services for those ultimately found eligible. Gaps exist in available health services and resources for medications and therapy. Many went without care. Some facilities helped AIs access care by going around the rules.

Conclusions: Significant health disparities will continue for AIs until a seamless health care system can provide comprehensive care and bridge gaps between urban and rural (reservation) areas. State programs could benefit from training front line, eligibility case managers on IHS limits. Breast and Cervical Early Detection programs could be models for health screening and care.