•Outdated, underfunded, and understaffed facilities cannot provide care beyond non-emergency hospitalization, let alone culturally competent or specialty care.

•Community divestment of surrounding reservations and IHS centers is correlated with low provider retention, diminishing the quality of care and patient-provider relationships.

•Many tribes do not have direct control over community health programs and services due to the need for federal approval, limiting their autonomy.

•Members of federally recognized tribes are not automatically insured outside of IHS providers. Lack of insurance exacerbates disparities due to prohibitive referral costs, inaccessibility of resources outside federal provisions, and low adherence to care.


Criticisms of the IHS and Federal Healthcare Providers

A division of the United States Department of Health and Human Services serving as the principal healthcare provider for the 500+ federally recognized tribes in America.


Grand Valley State University

Established by Constitutional and Supreme Court precedence, the trust responsibility requires the government to provide essential health services and enact federal mandates to protect Native American and Alaskan tribes and their descenants. 

The US goverment has a moral and legal obligation to maintain government-to-government relationships with tribes and honor their expectations, but this same doctrine also limits the autonomy of tribal leaders in community decisions involving protected land.

Doctrine of Trust Responsibility

Cromer, K. J., Wofford, L., & Wyant, D. K. (2019). Barriers to healthcare access facing American Indian and Alaska Natives in rural America. Journal of Community Health Nursing, 36(4), 165–187. https://doi.org/10.1080/07370016.2019.1665320

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