title: Big changes in the Indian Health Service: are nurses aware?
abstract: Unparalleled challenges currently face the Native American health care system. These challenges are a result of several factors, including (a) external pressures to reduce the overall cost of health care in the United States, (b) increased assumption of responsibility for delivery of health care by tribal governments, (c) decreased direct supervision by the Indian Health Service (IHS), (d) insufficient funding for Indian health care, and (e) increased interest of managed care to contract with tribal service units for health care. This article explores the opportunities and challenges facing Native American health care delivery and examines nursing policy issues pertinent to the current state of the IHS.
authors.affiliation: University of Iowa College of Nursing, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Holkup
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health / Q000208:ethnology; D003256:Community Participation; D003363:Cost Control; D018864:Cultural Diversity; D003659:Decision Making, Organizational; D005544:Forecasting; D018166:Health Care Reform / Q000458:organization & administration*; D006291:Health Policy; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006801:Humans; D007198:Indians, North American / Q000523:psychology / Q000706:statistics & numerical data; D008329:Managed Care Programs / Q000458:organization & administration; D017146:Models, Organizational; D020380:Needs Assessment; D009726:Nurses / Q000523:psychology; D016746:Transcultural Nursing; D014481:United States; D016549:United States Indian Health Service / Q000458:organization & administration*