title: The use of ambulatory health care services by American Indians with disabilities.
abstract: Although most American Indians and Alaska Natives have access to health care through the Indian Health Service (IHS), it is uncertain whether IHS is able to provide all necessary health services to those with disabilities. Although IHS eligibles can use health services other than those provided or sponsored by IHS, this may be precluded by high rates of poverty, low rates of other health insurance coverage, and the lack of private providers in many areas inhabited by this population. Using data from the 1987 Survey of American Indians and Alaska Natives--the only nationally representative health care survey of persons eligible for IHS--this study examines the use of ambulatory health care for IHS eligibles with disabilities. Comparisons with the total US population showed similar rates of ambulatory care use for most categories of disability, but a higher frequency of use for the total US population. Findings also show that IHS provides most of the health care for its eligible population, although non-IHS care is also used. After controlling for the effects of sociodemographic characteristics and health insurance coverage, variables indicating disabilities due to health problems were found to have statistically significant effects on the likelihood of using non-IHS care. Furthermore, persons with activity limitations had a higher than average likelihood of using most of their health care at non-IHS providers. These findings suggest that for some persons with disabilities, it is necessary to supplement IHS care with services from other providers.
authors.affiliation: Center for General Health Services Intramural Research, Agency for Health Care Policy and Research, Rockville, MD 20852.
authors.forename: P J
authors.initials: PJ
authors.lastname: Cunningham
authors.forename: B M
authors.initials: BM
authors.lastname: Altman
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D003710:Demography; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005380:Financing, Government; D006297:Health Services Accessibility; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D012959:Socioeconomic Factors; D014481:United States; D016549:United States Indian Health Service