title: Health care for American Indian and Alaska native women.
abstract: BACKGROUND
  Many American Indian and Alaska Native (AIAN) women serve in the military and are eligible for healthcare from both the Veterans Health Administration (VHA) and the Indian Health Service (IHS). Little was known about these women's patterns of health care utilization when VHA and IHS executed a resource-sharing agreement in 2003 to improve access and health outcomes.
  
  
  OBJECTIVE
  We sought to describe women's healthcare utilization in VHA and IHS.
  
  
  METHODS
  We conducted a descriptive secondary data analysis of linked IHS and VHA administrative records from fiscal years 2002 and 2003 for women among all IHS beneficiaries who were veterans or used VHA for health care (n = 64,746).
  
  
  RESULTS
  Among these IHS beneficiaries, 4,338 (6.7%) were female veterans and 1,518 (2.8%) were female nonveterans. Comparing IHS services to VHA, the VHA provided the majority of outpatient specialty care to veterans, providing 89.9% of diagnostic and imaging services, 84.4% of mental health care, and 78.1% of physical medicine and rehabilitation. Conversely, the IHS provided the majority of ambulatory and inpatient care for obstetrics and gynecology to these veterans. Dual users received primary care from both organizations. Nonveterans generally accessed VHA under sharing agreements and their use of health care was generally limited to outpatient diagnostic and imaging.
  
  
  CONCLUSIONS
  The VHA seems to supplement healthcare provided by the IHS for female AIAN veterans, as well as for a small proportion of nonveterans. The VHA and the IHS have developed specialized and complementary expertise, which might be aligned to serve the needs of female AIAN veterans.
authors.affiliation: VA Greater Los Angeles Healthcare System, Geriatric Research Education Clinical Center, Sepulveda, California 91343, USA. Josea.Kramer@va.gov
authors.forename: B Josea
authors.initials: BJ
authors.lastname: Kramer
authors.forename: Stella
authors.initials: S
authors.lastname: Jouldjian
authors.forename: Donna L
authors.initials: DL
authors.lastname: Washington
authors.forename: Judith O
authors.initials: JO
authors.lastname: Harker
authors.forename: Debra
authors.initials: D
authors.lastname: Saliba
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
mesh_terms: D000328:Adult; D000413:Alaska / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007297:Inpatients / Q000706:statistics & numerical data; D008875:Middle Aged; D014481:United States; D016549:United States Indian Health Service / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*; D016387:Women's Health / Q000208:ethnology*; D014932:Women's Health Services / Q000706:statistics & numerical data