In a comment to my previous post, Briwei asked what I thought would fix the Indian Health Service. Instead of just responding in a comment, I thought it was worth posting my opinion on this.
The first thing that would really help is if Congress reauthorized the Indian Health Care Improvement Act. From two and a half decades, the Act provided both a framework and a philosophical cornerstone of priorities for Indian health care. Initially passed in 1976 and renewed several times since, the Act expired in 2001. Coincidentally, health disparities between Indians and non-Indians grew in several areas right after that.
Several attempts have been made since 2001 to reauthorize the Act, but this administration has not been receptive to it. The biggest hurdle, no doubt, is money. See it's perfectly acceptable to spend twice as much per capita on the health care of Federal prisoners as we do on American Indians and Alaska Natives.
Another area where Congress could help would be creating some sort of cooperative bridge between the three disparate delivery systems that exist currently: the Federally run Indian Health Service, the Tribally run programs under the umbrella of the Indian Health Service, and the NGO-run urban Indian health programs (who traditionally have received at least some funding from IHS, though this minimal funding has been threatened time and again by the current administration). Since Tribes gained the ability to contract/compact with IHS to manage their own health care delivery systems, competition for funding between Tribes for health care funds has grown. This competition is not always conducive to cooperation in other areas, such as shared priorities, research, and information sharing. In order to truly make strides in the health status of American Indians and Alaska Natives, all Indian health programs need to work together.
Those two things would go along way to improving the situation, as would just a basic overall increase in funding. The per capita spending data is just horrific. In addition, the system has been so neglected that many of the facilities, and much of the equipment within those facilities, are crumbling and outdated. There should be a special initiative to bring facilities and equipment, if not up-to-date, at least into this century.
I don't claim to be an expert. All of this is just my opinion based on a couple of months of passion-driven research. I hope to leverage that material into my next research project for the next health care management class that requires one. The Universe knows that I have a pile of data to work with that can be analyzed from many different angles.