Heads of Indian Health Service, Hispanic doctors speak out on reform

NPR interviews Dr. Elana Rios, president of the National Hispanic Medical Association (NHMA), on the one-third of Hispanics in the U.S. who are uninsured. She says the reasons are cultural as well as economic: "Hispanics have health beliefs that are unique, lots of traditional ways of taking care of disease with teas and herbs and other things. And so families don't send their children or young adults to doctors. Another reason is other Hispanics come from other countries where their government provides health insurance." She also points to problems with trust: "Hispanics cannot entrust these authority figures, and let alone government, because we have mixed families with undocumented grandparents who don't want to be deported back to where they come from."

Rios says affordable health insurance would help solve the problem, along with "lots of education and outreach of the importance of purchasing health insurance." The NHMA "agrees with President Obama to have this health care reform system be changed for American citizens and those eligible to participate for health reform, and that does not include illegal and undocumented" ('Morning Edition,' Wertheimer, 9/23).

NPR also interviews Yvette Roubideaux, director of the Indian Health Service (IHS), on "what the rest of the country can learn" from the program. The IHS was started in 1955 and provides care for "about half of this country's 4.3 million American-Indians and Alaskan natives" with a network of more than 600 hospitals and clinics located on or near reservations. Roubideaux says that historically, the program has "had difficulty meeting the needs and the growing demands of the patients it serves with the limited budget that it has." It has also "had difficulty recruiting doctors to work in rural and remote areas."

The IHS is not a single-payer system: Roubideaux explains that at some facilities, more than half of the total budget comes from billing to Medicare, Medicaid and private insurance. She adds that the quality of care from IHS 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." But, "sometimes the budget doesn't stretch far enough for us to do more of the preventive practices," she explains ('Tell Me More,' Martin, 9/23).

Related KHN column: The Indian Health Service Paradox