American Indians (AIs) typically have poorer health outcomes than any other racial or ethnic minority group in the United States. This includes an increased risk for cancer, diabetes, injury related mortality, and infant mortality. AIs tend to have the highest rates of poverty and low rates of insurance coverage. Much of the AI population uses the Indian Health Service (IHS), which provides health care services to AIs on or near reservations.
A study published in Medical Care, “Barriers to Care Among American Indians in Public Health Care Programs” by Dr. Kathleen Call, et al., examines the extent to which reported barriers to health care services differ between AIs and non-Hispanic Whites. The study used a statewide stratified random sample of Minnesota health care program enrollees. The survey was analyzed using a logistic regression model that accounted for the complex survey design. The study examined barriers to using health care services, such as costs, geographic barriers, cultural barriers, lack of confidence or trust in providers, and perceived discrimination.
As noted by the authors, Minnesota is consistently ranked among the healthiest states, but the gap in health outcomes between AIs and Whites is striking. Despite access to care through the IHS, barriers to using health services continue to exist and are somewhat different for AIs compared to non-Hispanic Whites.
The largest statistically significant differences between AIs and Whites were:
- issues of transportation difficulties (more AIs reported)
- work-family responsibilities (more AIs reported)
- lack of cultural understanding by providers (more AIs reported)
- racial/ethnic discrimination (more AIs reported)
- not being able to see the desired doctor (more non-Hispanic whites reported)
Barriers reported by parents were slightly different, with issues of trust, lack of provider understanding, operating hours, and discrimination being significantly more of a concern for AIs. Moreover, the article suggests that providers must address barriers experienced by AIs to improve accessibility, acceptability, and quality of care for the AI patient.
Although health disparities for AIs are well documented, the experiences of AIs within the health care system have not been satisfactorily investigated. This article illustrates different barriers for the two populations groups and contributes to the conversation about the lack of primary care providers for AIs. Having consistent providers might enable rapport and trust building and could begin to address the extreme health disparities. A consistent provider might also eliminate the cultural discrimination AI patients experience by encouraging an understanding of the cultural and health practices of AI populations over time.
Jordyn Gunville