Native Americans, Alaska Natives Overcome Hurdles to Health Care

MICHEL MARTIN, host:

This is TELL ME MORE, from NPR News. I'm Michel Martin.

Coming up, they don't necessarily follow through, but a new survey shows that Asian-American women are more likely to think about suicide than other groups. Why might that be? We'll ask the lead researcher on the study in a few minutes. And a woman who talks candidly about her own struggles.

But first, more on health care. A newsmaker interview with a woman with rare insights into the health care debate. She oversees care for a large diverse underserved population, many of whom have significant health issues. Resources are limited but she still manages to offer care at low or no costs to patients. Intrigued? She is the director of the Indian Health Service. It's been around since 1955, and about half of this country's 4.3 million American-Indians and Alaskan natives get care through the Indian Health Service or IHS.

To hear more about the IHS, we have invited Dr. Yvette Roubideaux. She is the director of the Indian Health Service. She's a member of the Rosebud Sioux Tribe of South Dakota. She is the ninth director and the first woman to hold that post. And she joins us now from her office in Rockfield, Maryland. Welcome, doctor. Thank you so much for speaking with us.

Dr. YVETTE ROUBIDEAUX (Director, Indian Health Service): Thank you.

MARTIN: Now doctor, not many people I think outside of the - some parts of the country are familiar with the Indian Health Service. So can you tell us, how did the system start? How did the program start?

Dr. ROUBIDEAUX: Well, the Indian Health Service is an agency in the Department of Health and Human Services. And it was developed based on the trust responsibility that the federal government has to provide health care for American-Indians and Alaskan natives. So, it was established in 1959 and it consists of a network of over 600 hospitals and clinics located on Indian reservations or near them throughout the country.

MARTIN: So, as I understand it, you have to either live on the reservation or live near it to receive care. So, ironically, you can't get care through the IHS anymore.

Dr. ROUBIDEAUX: Yes, I am technically an urban American Indian living in the Washington, D.C., area and we don't have an Indian Health Service or hospital near here. So, I don't have access to a source of health care that's been important to me for much of my life.

MARTIN: As I understand it, part of what motivated you to become a doctor was that you had some unhappiness with the care that you got from the IHS when you were growing up. Can you talk more about that?

Dr. ROUBIDEAUX: Yes. The challenge that the Indian Health Service has is that, historically, it's had difficulty meeting the needs and the growing demands of the patients it serves with the limited budget that it has. And so, when I was a child, I would go to the Indian Health Service Hospital in my city. And I just remember waiting a long time to see doctors and then I never really saw the same doctor each time, because the Indian Health Service has always had difficulty recruiting doctors to work in rural and remote areas. And I also realized at some point that I had never seen an American-Indian physician.

MARTIN: Well, when you say long waits to see a doctor, what do you mean?

Dr. ROUBIDEAUX: Well, the problem that we face is recruiting doctors in rural areas. And so, if a hospital is supposed to be staffed with, for example, 10 doctors, they may only have five on staff. And so, those doctors are the only doctors available to see large numbers of patients. And so that means, unfortunately, there's a wait for services.

MARTIN: So, it could be what, four hours, five hours?

Dr. ROUBIDEAUX: Well, it's a lot better now than when I was a child. When I was a child, I routinely remember waiting three to four hours, on average, to see a doctor. But I know that there's been some improvements in our health programs to where people are able to even get same day appointments and to see doctors much more quickly.

MARTIN: How is this paid for?

Dr. ROUBIDEAUX: The Indian Health Service is paid for through congressional appropriations annually. So, every year there's a budget for the Indian Health Service.

MARTIN: So it's essentially a single-payer system? It is a single-payer system.

Dr. ROUBIDEAUX: Well, not really because in addition to the federal government contributing funding, our facilities are also able to bill for Medicare, Medicaid and private insurance. And so those are important sources of revenues for our facilities. And in fact, over half of some of the budgets of our facilities rely on third party collections.

MARTIN: But that would be - it's all the federal government, isn't it, even though it comes from different funding pools, right?

Dr. ROUBIDEAUX: Except for the private insurance.

MARTIN: How would you assess the quality of care offered by the Indian Health Service?

Dr. ROUBIDEAUX: Well, I think the quality of care that we offer is sort of a mixed picture. If you look at the quality of care over time, since 1955, there are some areas where we've made great improvements. We've been able to reduce mortality for some conditions and especially in the area of diabetes, we've been able to reduce care to the point to where I think it's actually better than what people did in the general U.S. health care system.

However, there really are some areas where we do need to improve. Preventive care is one area, where the resources that we have need to be used more for urgent and emergent care and taking care of the daily needs of patients and sometimes the budget doesn't stretch far enough for us to do more of the preventive practices, but we would like to do better at that.

MARTIN: Would you say that the Indian Health Service rations care?

Dr. ROUBIDEAUX: Well, I don't like the use of that term because it's so negative. I really think that the Indian Health Service is just trying to do the best that it can with the resources it has, to provide the best care possible. And unfortunately, what's true of everybody, if your budget is limited, you have to make some really hard choices about what you can fund now versus what you can fund later or what you're not able to provide.

MARTIN: Why did you want to do this job?

Dr. ROUBIDEAUX: Well, I'm really honored to have been appointed to do this job by the president. It certainly was a surprise for me to receive the call, to be asked to do this job but - and a lot of people would say, boy, you're taking on a huge job of trying to improve this large federal health care system. But I really do believe that we're at a unique moment in history where we have the support of a president, we have the support of our administration and there is bipartisan support in Congress to improve the Indian Health Service and try to get more resources towards our mission.

And so, I really think that it's an exciting time and I really do think that we can make great strides towards furthering our mission over the next few years. I also became a doctor because of my desire to want to improve health care for American Indians and Alaskan natives. And fortunately, this position gives me sort of the ultimate opportunity to try to do that.

MARTIN: Dr. Yvette Roubideaux is the director of the Indian Health Service, a part of the U.S. Department of Health and Human Services. As she told us, she is a member of the Rosebud Sioux Tribe of South Dakota. She is the first woman to hold this post. And she was kind enough to join us from her office in Rockfield, Maryland. Thank you so much, doctor, for speaking with us.

Dr. ROUBIDEAUX: Thank you.

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