Health Im Impact Assessment: : In Indian Health Services Budget - - PowerPoint PPT Presentation

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Health Im Impact Assessment: : In Indian Health Services Budget - - PowerPoint PPT Presentation

Apr 01, 2024 109 likes •471 views

Health Im Impact Assessment: : In Indian Health Services Budget and Urban In Indian Budgeting Decisions http://nmhep.org/resources/hia-reports/ihs/ Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache);

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Health Im Impact Assessment: : In Indian Health Services Budget and Urban In Indian Budgeting Decisions

http://nmhep.org/resources/hia-reports/ihs/

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Acknowledgements

  • HIA Team
  • Emily Haozous
  • Valerie Rangel
  • Shandra Burton
  • NM Health Equity Partnership Technical Support Team
  • David Gaussoin
  • Jinelle Scully
  • Richard Wright
  • Jessica Jensen
  • Community Advisory Board
  • Kathryn Harris Tijerina
  • Delight Talawepi
  • Anne Wheelock Gonzales
  • David Sloan
  • Nancy Davis
  • Cyndi Woodall-Hall
  • Edie Brycelea
  • Santa Fe IHS Hospital
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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

What is an HIA?

Health Impact Assessments (HIAs):

  • Evaluate the impact of a

public policy with the goal

  • f promoting health, health

equity, and social justice

The value of HIAs is that they:

  • Engage the public and other

stakeholders throughout the process

  • Consider the many layers that

influence health

(from individual uncontrollable risk factors like age, genetics, and gender, to controllable risk factors like diet, exercise, and coping)

  • Can be used to inform

recommendations on a specific policy

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

6 Steps to an HIA

Screening

Determines the need and value of an HIA.

Scoping

Determines which health impacts to evaluate, methods for analysis, and a work plan.

Assessment

Provides a profile of existing health conditions and an evaluation of potential health impacts.

Recommendations

Provides strategies to manage identified adverse health impacts.

Reporting

Develops the HIA report and communicates findings and recommendations.

Monitoring

Tracks impacts on decision-making processes and the decision itself, and impacts of the decision on health determinants.

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Purpose

Examine the impact of federal underfunding of the Santa Fe Indian Health Service Hospital on the inter- tribal community of American Indian and Alaska Natives in the metropolitan Santa Fe area

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Background

  • Urban American Indians/Alaska Natives
  • Off-reservation population
  • Causes:
  • Federal Relocation policies
  • Boarding schools
  • Economy/ unemployment/ poverty
  • Unfriendly political climate
  • Personal reasons
  • Indian Health Service - Treaty obligation
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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Background Data Sources

  • NM Department of Health​
  • Indian Health Service
  • CDC​
  • Annie E. Casey Kids Count!

Annual Report​

  • Surveillance, Epidemiology, End

Results (SEER) Tumor Registry​

  • The Joint Commission
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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

AIAN Child Health in NM

5 10 15 20 25 30 35 40 45 50

% AIAN Families Living in Poverty % All Families living in poverty %AIAN Families with no parent in workforce % All Families with no parent in workforce AIAN family income (in thousands) All family income (in thousands) % AIAN children with no health insurance % NHW children with no health insurance % Hispanic or Latinx children with no health insurance

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Vital Statistics- Santa Fe County

10 20 30 40 50 60 70 80 90 Age 45-49 Age 50-54 Age 55-59 Age 60-64 Age 65-69 Age 70-74 Age 80-84 Age 85+

Life Expectancy- Average Number of Years Remaining

Male AIAN Male NHW Female AIAN Female NHW Source: NM Dept of Health

AIAN females have shorter life span than NHW females AIAN males have shorter life span than NHW males

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Malignant Neoplasms

50 100 150 200 250 300 350 400 450 AIAN Incidence AIAN Mortality NHW Incidence NHW Mortality

Incidence and Mortality, Santa Fe County, Both Sexes, All Ages, 2008-2012, Age Adjusted (95% CI)

Incidence Mortality AIAN (includes Hispanic) 277.2 (208.4, 360.2) 91.6 (50.0, 150.4) NHW 391.8 (371, 427.9) 125.7 (115.8, 136.5)

Source: SEER Registry

AIAN are diagnosed at lower rates as NHW, but die at the same rates as NHW

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Methods

  • Community Advisory Board
  • Members of the Urban AI/AN community
  • Professionals-
  • Lawyer
  • Policy expert
  • Public education
  • Art retail
  • Artist
  • Art education
  • Healthcare
  • Mental health
  • Consulted at all key decision-making points
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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Methods

  • Data Collection
  • Community Survey
  • Drawn from larger needs assessment question bank
  • Amended to meet project needs
  • Focused based on Community Advisory Board priorities
  • Qualitative Interviews
  • Analysis
  • Quantitative Data: Descriptive statistics and overall data trends
  • Qualitative Data: Thematic analysis
  • Total sample
  • 165 anonymous surveys completed
  • pencil/paper and online survey
  • 17 confidential qualitative interviews
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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Table 1. Demographic Characteristics Characteristics

% (N=165)

Characteristics

% (N=165)

Gender Income

< $10,000 17.91 24 Male 29.71 41 $10,000-$19,999 11.94 16 Female 69.57 96 $20,000-$29,999 13.43 18 Other 0.72 1 $30,000-$49,999 19.40 26 Age $50,000-$74,999 9.7 13 18-24 9.45 12 More than $75,000 9.7 13 25-34 17.32 22 I prefer not to answer 17.91 24 35-44 23.62 30

Number of Children

45-54 18.9 24 47.15 58 55-64 19.69 25 1 13.82 17 65+ 11.02 14 2 19.51 24

Education Attained

3 15.45 19 11th Grade 3.05 4 4 4.07 5 High School Diploma or GED 39.42 54 Associates Degree 23.36 32 Bachelors Degree 24.09 33 Masters Degree 3.65 5 Professional Degree 2.92 4 I prefer not to answer 2.65 5

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Survey Demographics: Age

5 10 15 20 25

18-24 25-34 35-44 45-54 55-64 65+

% Response

Age

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Survey Demographics: Education Completed

5 10 15 20 25 30 35 40 45

11th Grade High School Diploma or GED Associates Degree Bachelors Degree Masters Degree Professional Degree I prefer not to answer

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

5 10 15 20 25

< $10,000 $10,000-$19,999 $20,000-$29,999 $30,000-$49,999 $50,000-$74,999 More than $75,000 I prefer not to answer

Survey Demographics: Income

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

84% 6% 4% 6%

Enrolled Member Descendent Not enrolled Member None of the Above

Survey Demographics: Self-report Tribal Affiliation

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Tribal Affiliations

19% 10% 1% 12% 58%

No Answer Southern Plains Pacific Northwest Northern Plains Southwest Tribes

156 different tribes were represented in the survey

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

5 10 15 20 25 30 35 40

Underweight <18.5 Healthy / Normal 18.5 - 24.9 Overweight 25 - 29.9 Obese 30 - 34.99 Seriously Obese 35+ Male Female

Survey Demographics: Body Mass Index (BMI), % per Category, by Gender

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Reasons Participants Could Not Receive Needed Health Care in Past 12 Months

5 10 15 20 25 30

No disability access at clinic Lack of childcare/eldercare Other Lack of transportation Too far, distance Inconvenient office hours No health insurance High cost of care Too long of a wait for appointment Not eligible for CHS

%

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Top FIVE things that most negatively affect the health and well-being of Native Americans and Alaska Natives in Santa Fe County

0.1 0.2 0.3 0.4 0.5 0.6 0.7

Lack of respect for AI/AN culture Lack of access to quality health services Mental Illness Poor Nutrition Chronic Disease

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Most important health problems in the community, ranked #1 and #2

10 20 30 40 50 60 70

Lung Disease Depression Cancer Suicide Obesity Heart Disease/Stroke Diabetes 7 6 5 4 3 2 1

Rank 1-7

% Rank 2 % Rank 1

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Where do you go when you are sick or need advice about your health?

10 20 30 40 50 60 70

I don’t go anywhere Community Clinic Other Private Doctor Hospital/Emergency Room IHS 6 5 4 3 2 1

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Healthcare Coverage, by %

0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

In the last 12 months, how often did you eat less

  • r ration your food because there was not enough

money for food (by %)?

17.39 36.23 46.38

  • ften

sometimes (at least once) never

53.62 46.38

Combining often and sometimes

Often + Sometimes Never

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

What nutritional services do you or your family use?

5 10 15 20 25 30 35

% Selected

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Services desired but not currently offered at Santa Fe IHS, Ranked by importance

5 10 15 20 25 30 35 40 45

Dental Specialists: Oral Surgeon, Periodontist, Endodontist Same Day Surgery Obstetric Care Colonoscopy/Endoscopy Mammogram Substance Abuse Detox Dialysis Integrative Medicine (acupuncture, massage, guided imagery,… Podiatry Inpatient Psychiatric Unit Other % Selected

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Over the past month, how satisfied were you with your healthcare?

10 20 30 40 50 60

Very Satisfied/ Satisfied Neutral Dissatisfied/ Very Dissatisfied

%

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Diet/ Nutrition Diabetes Mental Health/ Addiction Services Chronic Illness/ Disease Prevention

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Recommendation #1 Fund the Indian Health Service at 100%

  • f need

Justification:

AIANs experience a low life expectancy, with higher incidence rates of many preventable diseases. Funding the Indian Health Service (and Compact 638 centers) at 100% of need will allow the federal government to honor their treaty obligations with sovereign AIAN nations. Through provision of full funding, health outcomes will improve, allowing for longer life expectancy, better quality of life, and decreases in chronic illness for users of the IHS.

Diet/ Nutrition Diabetes Mental Health/ Addiction Services Chronic Illness/ Disease Prevention

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Recommendation #2

Address food insecurity through the creation of a Food Bank and expansion of Nutrition Services to meet the needs of the entire Santa Fe Service Unit IHS Hospital community

Justification:

Food insecurity was identified as a serious problem for more than half of the survey respondents in this HIA. Extending regional resources with a food bank operating from the Santa Fe Service Unit IHS Hospital will bring needed nutritional resources to the community. Open access to existing nutritional counselling will improve knowledge. This recommendation will improve

  • verall health and broaden nutritional health within the community.

* Recommendation made prior to Nutrition Services expansion at IHS

Diet/ Nutrition Diabetes Chronic Illness/ Disease Prevention

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Recommendation #3

Increase IHS funding to improve mental and behavioral health programs

Justification:

Mental and behavioral health needs were identified as specific concerns by respondents in this HIA. While there are some limited services available, we recommend that funding increase to mental and behavioral health programs to allow for more access to periodic psychiatric care, couples therapy, inpatient and

  • utpatient addiction services, inpatient and outpatient psychiatric care, and

emergency psychiatric care. Benefits from addressing this need may include decreased rates of premature death from alcohol, drug abuse, and mental illness.

Mental Health/ Addiction Services Chronic Illness/ Disease Prevention

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Recommendation #4

Eliminate Purchased/ Referred Care eligibility by area service unit and replace with funding that follows the patient

Justification:

Allocation and budgeting of PRC funds based on Service Unit population does not account for the considerable AIAN population living away from their service unit. By changing this policy to link funding to the patient, the funding allows for more equitable distribution of payment for AIAN healthcare, allows for PRC access for out-of-service-area AIANs which will improve health

  • utcomes, and it would decrease use of urgent care, emergency room visits, and out-of-pocket

healthcare costs for Urban AIANs.

Diet/ Nutrition Diabetes Mental Health/ Addiction Services Chronic Illness/ Disease Prevention

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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

What Next?

  • Share your thoughts with:
  • Tribal Elders
  • Tribal Leaders
  • Tribal Health Board
  • IHS Health Board Members
  • Educate your elected officials
  • Senators
  • Congresspeople
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Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

What Next?

  • Go to http://nmhep.org/resources/hia-reports/ihs/
  • Comment on the report
  • Share the report