Health Insurance Plans and Prices for Alaska Men (Alaska Health Care Book 2)


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There is always an assump- tion made [by non-Indian providers] that any illness presented by an Indian patient is alcohol-related or other forms of substance abuse. One of the staff members on the conference call went on to indicate that the ability to pay or the possession of a bonafide authorization does not always translate into quality care for Indian patients.

Another tribal health program staff member elaborated: Even [our] tribal members with insurance do not receive quality care in the private sector because of cultural insensitivity and racism. A majority of those interviewed indicated or provided examples per- haps indicating that Indian patients are more likely to experience discrimi- nation by providers or employees working in non-IHS or non-tribal health facilities.

Comments by a number of the interviewees, however, did not distinguish between outright racial discrimination and situations where providers might refuse to treat all patients with Medicaid or Medicare insurance. One tribal leader, for example, defined a situation as discrimi- natory when a fellow tribal member referred for knee surgery was re- fused by a specialist because the tribal member was on Medicaid.

Other examples were more specific and linked to racial discrimina- tion. For example, one provider in Oklahoma reported that compared to non-Indian clients, Indian clients placed in a nearby psychiatric facility under Emergency Detention Order either did not receive immediate evaluation or were not immediately transferred to an appropriate treat- ment facility. He reports that Indian clients are kept much longer in the locked facility before they are evaluated or are referred to other treatment facilities. Other examples also give glimpses of discriminatory action, at least from the view of the Indian patients.

One longtime urban health program administrator reported that a considerable number of Indian patients they refer out to the private sector for specialty care or x-rays may not receive the service because the patients either do not feel welcomed or are treated with disrespect. Another IHS provider cited the results of a study that indicated a form of discrimination in providing treatment. The study examined the kinds of breast cancer treatments received by Indian women in one region of the Southwest.

The study team found that compared with non-Indian women, Indian women are more likely to undergo a radical mastectomy rather. Lack of cultural sensitivity or stereotyping has also been presented as another form of discrimination or as contributing factors to discrimina- tion. A few of the respondents also mentioned that some Indian patients also want extra time to consult or to seek the services of their traditional tribal healers before consenting to a major treatment plan.

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Such requests are familiar and frequently honored by providers in IHS or tribal or urban based health programs, but are not familiar to providers in the private sector. Providers and administrators of the urban programs, however, find it difficult to provide patients in the cities with access to traditional tribal healers due to distance and differing intertribal needs for this service. Some of those interviewed also described ways they have attempted to address discrimination. One IHS director of a consortium of tribal health programs in the eastern United States reported that they constantly try to educate agencies or entities that deny services to Indian patients to teach them that as citizens of their respective states, Indians are eligible for state, county, or local health resources.

He admitted, however, that the educational efforts are difficult because his organization has to work with. Other tribal health program administrators said they attempt to lessen the blow of discriminatory practices by having Community Health Representatives paraprofessionals escort patients to non-tribal or non-IHS facilities. The escorts are asked to help with translation or to serve as patient advocates.

In another region of the country, communi- ties were able to vote in a tribal member to the local non-Indian hospital board, and once on the hospital board, the representative despite strong objection by fellow board members was able to convince the hospital to hire tribal persons to help coordinate care for Indian patients referred to that hospital.

One noted exception mentioned by a number of individuals interviewed has been the recent special congressional five-year diabetes prevention initia- tive that has funded a number of communities to initiate diabetes preven- tion programs. IHS providers also recount a few longstanding efforts to address health disparities, such as their ongoing aggressive immunization pro- grams, efforts to improve sanitation and water supply for tribal commu- nities, improvement in standards of care for clinical patients through chart audits, and increased screening for a number of preventable mortalities, such as diabetes, cancer, heart disease, etc.

Tribally managed programs that are able to tap into other resources also mentioned a number of programs that they have initiated, such as wellness programs, adolescent treatment programs, substance abuse treat- ment, integration of traditional tribal healing practices, and disease pre- vention programs. In general, most agreed that closing the gap on health disparities for this population would require a national and federal recommitment, es- pecially in the form of increased federal funding that would allow pa- tients to have access to specialty care.

For several decades, the goal of the federal government has been to raise the health of this population to the highest level in order to lessen the gap of health disparities. The road taken by tribes and the IHS to accomplish this goal continues to be fraught with difficulties and detours.

The difficulties in closing the gap of health disparities continues to be underscored by a number of indicators, including mortality statistics for specific diseases that significantly exceed those in the majority culture. Numerous factors have been identified as contributing to these dispari- ties, including, but not limited to, poverty, access to healthcare, years of neglect, diminishing resources for disease prevention, longstanding so- cial and cultural disruptions, and a widening gap in healthcare spending that forces rationing of healthcare.


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Moreover, some patients are unable to receive timely care due to jurisdictional and bureaucratic disputes over which agency is the first party payer. Racial discrimination and stereotyping of Indian patients, especially by providers in the private sector, is commonplace.

Its consequences have left patients without care, with inadequate care, or in some instances, with inappropriate care, such as radical mastectomy for early stage cancers. Lack of adequate funding ripples into all aspects of the healthcare delivery systems, which has affected the ability of the Indian health pro- grams to recruit and hire staff, to commit to long-range health planning, to target resources for prevention and research, and to ensure culturally appropriate healthcare.

Tribal and urban-based Indian health programs have developed strategies to off-set the ever growing financial hardships, but they, along with IHS, are now facing other new challenges, such as managed care. Persistent Disparities Put Patients at Risk. Albuquerque, NM.

August Indian Tribes as Sovereign Gov- ernments. Bergman, Abraham B. The Milbank Quar- terly. Braden JJ and K Beauregard. Grady, Meredith and Tim Edgar. Washington, DC: Westat. Grossman, David C. Medicaid Bureau.

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Publication Number Trends in Indian Health. Rockville, MD: U. Indian Health Service. Regional Differences in Indian Health. Year profile. Joe, Jennie R. Duane Champage, ed.

Health Insurance: Premiums and Increases

The Henry J. Kaiser Family Foundation. Kaiser Fam- ily Foundation. Kekahbah, Janice and Rosemary Wood.


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    New York: Oxford University Press. Meriam, Lewis. February Namias, Barbara. Washington, DC: July National Indian Health Board Reporter. Indian Health Care. Washington, DC: U.

    [email protected]: Why is health care in Alaska so expensive?

    Government Printing Office. Rhoades, Everett R. Public Health Reports. Schneider, Andy and JoAnn Martinez. Kaiser Family Foundation Policy Brief. Stern, E. Wagner and Allen F. The Effects of Smallpox on the Destiny of Amerindians. Trennert, Robert A. Albuquerque: University of New Mexico Press.

    Trujillo, Michael H. Unpublished Manuscript. Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received.

    In Unequal Treatment , a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities.

    How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider—patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions.

    The book concludes with recommendations for data collection and research initiatives.


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    • Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color. These forms usually take 30 to 45 days to process once we receive them. You can find this form under Manage My Account. If you purchased your plan from the state exchange Washington Healthplanfinder , please call them at Benefit Summary. Know before you go Be sure to review your benefit summary before visiting your doctor.

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      Log in to check benefits Or create your account. Some doctors and hospitals cost more than others! Summary of benefits and coverage As part of the Affordable Care Act of , all health plans must provide a summary of benefits in a standard four-page format. What are my benefits? I have an upcoming service and want to know what costs I'll be responsible for. How is preventive care covered?

      Health Insurance Plans and Prices for Alaska Men (Alaska Health Care Book 2) Health Insurance Plans and Prices for Alaska Men (Alaska Health Care Book 2)
      Health Insurance Plans and Prices for Alaska Men (Alaska Health Care Book 2) Health Insurance Plans and Prices for Alaska Men (Alaska Health Care Book 2)
      Health Insurance Plans and Prices for Alaska Men (Alaska Health Care Book 2) Health Insurance Plans and Prices for Alaska Men (Alaska Health Care Book 2)
      Health Insurance Plans and Prices for Alaska Men (Alaska Health Care Book 2) Health Insurance Plans and Prices for Alaska Men (Alaska Health Care Book 2)
      Health Insurance Plans and Prices for Alaska Men (Alaska Health Care Book 2) Health Insurance Plans and Prices for Alaska Men (Alaska Health Care Book 2)

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