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The Indian Health Service (IHS), an agency within the United States (U.S.) Department of Health and Human Services (HHS) is responsible for providing federal health services to American Indian and Alaska Native (AI/AN) people. The IHS is the principal federal health care provider and health advocate for Indian people.

Organizational Structure

The IHS organizational structure includes the Rockville, Maryland headquarters office and 12 administrative area offices located throughout the United States. The 12 IHS areas encompass a network of hospitals, clinics, and health stations.

Serving approximately 2.6 million American Indians and Alaska Natives from 573 federally recognized Tribes in 37 states, the IHS provides a wide range of clinical and public health services, along with community and facilities infrastructure services. Comprehensive primary health care and disease prevention services are provided through a network of hospitals, clinics, and health stations on or near Indian reservations. These facilities, which are managed by the IHS, Tribes, and Tribal organizations, are predominately located in rural and primary care settings. In addition, the IHS contracts with urban Indian organizations (UIOs) for health care services provided in some urban centers. The Indian health care system strives to provide comprehensive care through a network of IHS, Tribal, and urban health facilities and by purchasing health care services from non-IHS providers through the Purchased/Referred Care (PRC) program.

In 2018, the Indian health care system had more than 40,494 hospital admissions and almost 13.8 million outpatient medical care visits. The Indian health care system also provides dental services, nutrition services, pharmacy services, community health, sanitation facilities (water supply and waste disposal), injury prevention, and institutional environmental services.

A unique government-to-government relationship exists between Indian Tribes and the U.S. Government. Consistent with the government-to-government relationship and its statutory authorities, the IHS is committed to ensuring that comprehensive, culturally appropriate personal and public health services are available and accessible to AI/AN people. Over 60 percent of the IHS appropriation is administered by Tribes,[1] primarily through Self-Determination contracts or Self-Governance compacts. The IHS retains the remaining funds and delivers health services directly to the Tribes that choose to have IHS administer the programs. The IHS works closely with Tribal governments as they assume a greater role in improving health care in their own communities.

Tribal Consultation and Urban Indian Confer

IHS implements Tribal consultation[2] and urban Indian confer [3] policies to facilitate the involvement of Tribes and UIOs.

The IHS Tribal consultation policy states that consultation occurs to the extent practicable and permitted by law before any action is taken that will significantly affect Indian Tribes. The IHS is committed to regular and meaningful consultation and collaboration with Tribes. It is IHS policy to confer with UIOs, to the maximum extent practicable, whenever a critical event or issue arises, as defined in the policy, in implementing or carrying out the Indian Health Care Improvement Act (IHCIA). This policy is used to ensure that the health needs of the urban Indian population are considered at the local, area, and national levels when implementing and carrying out the IHCIA.

IHS Partnerships

The IHS has established partnerships to address AI/AN issues and strengthen services. Partnerships include local communities, not-for-profit organizations, universities and schools, foundations, businesses, and federal agencies such as the Department of the Interior (including the Bureau of Indian Affairs and the Bureau of Indian Education), Department of Justice, Department of Housing and Urban Development, and the Department of Veterans Affairs. These IHS partnerships impact AI/AN communities in critical areas, such as housing, education, public safety, and health care for Veterans. It is essential to continue to build upon these partnerships.

[2] 25 U.S.C § 1602 (5); 25 U.S.C 5301; 25 U.S.C § 5381.

[3] 25 U.S.C § 1660d(b); 25 U.S.C § 1602 (5); 25 U.S.C § 1631 (f); 25 U.S.C § 1665k(a)(2)(A)(vii).