Indian health care needs patient information and funds

By Will Chavez
Staff Writer 

OKLAHOMA CITY – Panelists speaking at the 22nd annual Sovereignty Symposium held June 3-4 said greater exchange of patient information and funding are needed for proper Indian health care. 

Speaking on the panel titled “Indian Health Care in an Era of Change,” Dr. Robert Roswell, assistant dean at the University of Oklahoma College of Medicine, said the U.S. “stinks” at lowering health care costs and improving health care quality.

“We have the highest health care costs on the planet, and yet our health care outcomes in this nation are among some of the poorest of economically developed countries,” he said. 

Roswell said the top issue facing Indian health care is sharing patient information among multiple providers. 

“Health care is inefficient, and health care is of low-quality because the various health care professionals involved with treating a patient in today’s complex medical world don’t have the ability to share information to know what another provider has done,” he said. 

Cherokee Nation W.W. Hastings Hospital in Tahlequah uses the Resource and Patient Management System to manage patient information, Roswell said, but more federal funding is needed to put RPMS in other tribal health and Indian Health Service facilities.

He said it is important for Indian health facilities to use patient information systems so facilities could connect to the Health Information Exchange infrastructure being created in Oklahoma that would allow tribal, IHS, Veterans Affairs, private and Medicare facilities and private insurers to share patient information. 

Jody Westby, American Bar Association Privacy Committee chairwoman, said a lack of information technology systems for Indian health care facilities impacts patient care. She said the $85 million given to IHS for information technology as part of the federal stimulus bill isn’t enough money for proper IT systems.

“The bottom line is $85 million for information technology systems, especially spread out over the entire Indian Health Service, is not very much money,” she said. 

Dr. Charles Knife Chief, medical director for Oklahoma Blue Cross and Blue Shield, said the HIE would cut service duplicity and save money. 

“You’re going to be able to manage somebody no matter where they go and be able to track their blood pressures throughout the year...it will improve the long term health of an individual and the management of their health,” he said. 

Knife Chief also spoke of the misconception of free Indian health care. 

“We paid a long time ago for these services and obligations of the federal government by virtue of the lands that were taken. The result of that pre-payment is what we see now – the obligation of the federal government to provide health care service to the American Indian,” he said. 

Though the U.S. is obligated for health care funds, it is not required to provide a set amount of funds annually, Knife Chief said. 

Roswell said 60 percent of state Indians rely on IHS and that Oklahomans with only IHS coverage are considered uninsured. He said 632,000 Oklahomans don’t have health care insurance and that Oklahoma has one of the highest uninsured populations. 

Knife Chief said Indian health care is funded at 51 percent of its need, which leads to a lack of health care access and facilities and contributes to poor health care for Indians. 

Because funding is short tribes need to be more efficient with funds, he said, and that tribes should emphasize preventive health care, disease management and wellness despite not seeing results from those efforts for five to 20 years.

“As Indian peoples, it’s not that we have a different type of diabetes, a different type of heart disease, a different type of anything, it’s just that we tend to get diagnosed at a later stage,” Knife Chief said. “We have tremendously high rates of these diseases compared to the population in general. Again, there’s not much difference in the disease process, it’s getting diagnosed and getting care after that.” 

Citing 2000 Census figures, he said the median age for Indians was 28, while the median age for the rest of the country was 35.3.

“It tells you there are not a lot of old American Indians around because of the disease process that happens and the lack of accessibility to health care,” he said.

Knife Chief said for the Indian population tuberculosis deaths are 750 percent greater than general U.S. populations, alcoholism is 550 percent greater, diabetes is 190 percent, unintentional injuries are 150 percent, homicide is 100 percent and suicide is 80 percent greater. The infant death rate is nearly twice the rate of the U.S. population, he said.

“That is just a sad comment, not only on the health status of American Indians, but their social status, economic status and educational status,” he said.