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Accessing HealthcareResponding to diversity$
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Judith Healy and Martin McKee

Print publication date: 2004

Print ISBN-13: 9780198516187

Published to Oxford Scholarship Online: September 2009

DOI: 10.1093/acprof:oso/9780198516187.001.0001

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The History and Politics of Health Care for Native Americans

The History and Politics of Health Care for Native Americans

Chapter:
(p.303) 16 The History and Politics of Health Care for Native Americans
Source:
Accessing Healthcare
Author(s):

Judith Healy

Martin McKee

Publisher:
Oxford University Press
DOI:10.1093/acprof:oso/9780198516187.003.0016

From the early 19th century, the US federal government has provided health care to Native Americans as a treaty obligation and in its role as trustee. The life expectancy of Indian people improved from the 1950s to 1990s to not far below that of other Americans, despite poverty and difficult living conditions, mainly due to reduced infant and child mortality from infectious diseases. From the 1980s onwards, many health programs were transferred from the Indian Health Service to tribal authorities (through contracts and compacts) in line with self-determination. Consequences of devolution include whether local programs are adequately funded to provide high quality health care, whether people not on reservations have entitlements to subsidised health care, while there are major cost implications of increasing recourse to private health care markets.

Keywords:   Native Americans, devolution, self-determination, Indian Health Service, tribal authorities

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