The Indian Health Service (IHS): An Overview - R43330

Elayne J. Heisler
Analyst in Health Services

The Indian Health Service (IHS) within the Department of Health and Human Services (HHS) is the lead federal agency charged with improving the health of American Indians and Alaska Natives. It aims to do so by providing health services either directly or through contracts or compacts with Indian Tribes (ITs) and Tribal Organizations (TOs) to approximately 2.2 million American Indians or Alaska Natives who are members of 566 federally recognized tribes. IHS also provides grants to Urban Indian Organizations (UIOs) under the authority of Title V of the Indian Health Care Improvement Act. More than half of all federally recognized tribes operate facilities or health programs, and more than one-third of IHS’s budget appropriation is administered by tribes.

The IHS health care delivery system serves federal reservations, Indian communities in Oklahoma and California, and Indian, Eskimo (Inuit and Yupik), and Aleut communities in Alaska. The system is organized into area offices, which are then further subdivided into service units. In FY2013, there were 12 area offices and 168 local service units. The IHS system is a mostly rural outpatient system focused on primary care. The system consists of five types of facilities: (1) hospitals, (2) health centers, (3) health stations, (4) Alaska village clinics, and (5) youth regional treatment centers. ITs and TOs may also operate other types of facilities or programs that exclusively focus on behavioral health concerns (such as alcohol and substance abuse). There are a total of 621 facilities in the IHS system; nearly half are health centers.

The IHS provides an array of medical services, including inpatient, ambulatory, emergency, dental, public health nursing, and preventive health care. The IHS does not have a defined medical benefit package that includes or excludes specific health services or health conditions. The majority of IHS facilities provide outpatient care, focusing on primary and preventive care including preventive screenings and health education. IHS provides services directly when possible; when needed services are not available, IHS beneficiaries may be referred to private providers for care. This is called purchased/referred care.

IHS also provides a number of health services that target common health conditions among IHS beneficiaries. These include services for diabetes prevention and treatment, behavioral health services including suicide prevention and methamphetamine treatment, and programs aimed at the prevention of infectious diseases. In addition to health services, IHS funds a number of activities related to its unique mission. These include construction and maintenance of IHS facilities, efforts to recruit and retain a skilled health workforce who will work at IHS facilities, and support for the overhead and expenses associated with contracts and compacts that the IHS enters into with ITs and TOs.

The federal government has long-standing involvement in Indian health. The Indian Health Care Improvement Act is the major authorizing legislation for the IHS. It was preceded by several laws that included more general authorization for federal Indian programs. A number of congressional committees exercise jurisdiction over legislation affecting the IHS, including its appropriations.

Date of Report: December 3, 2013
Number of Pages: 32
Order Number: R43330
Price: $29.95



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