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January 2004, Vol 94, No. 1 | American Journal of Public Health 53-59
© 2004 American Public Health Association


RESEARCH AND PRACTICE

Health Service Access, Use, and Insurance Coverage Among American Indians/Alaska Natives and Whites: What Role Does the Indian Health Service Play?

Stephen Zuckerman, PhD, Jennifer Haley, MA, Yvette Roubideaux, MD, MPH and Marsha Lillie-Blanton, DrPH

Stephen Zuckerman and Jennifer Haley are with the Urban Institute, Health Policy Center, Washington, DC. Yvette Roubideaux is with the College of Public Health, University of Arizona, Tuscon. Marsha Lillie-Blanton is with the Henry J. Kaiser Family Foundation, Washington, DC.

Correspondence: Requests for reprints should be sent to Stephen Zuckerman, Health Policy Center, Urban Institute, 2100 M St, NW, Washington, DC 20037 (e-mail: szuckerm{at}ui.urban.org).

Objectives. We compared access and utilization of health services among American Indians/Alaska Natives (AIANs) with that among non-Hispanic Whites.

Methods. We used data from the 1997 and 1999 National Survey of America’s Families to estimate odds ratios for several measures of access and utilization and the effects of Indian Health Service (IHS) coverage.

Results. AIANs had less insurance coverage and worse access and utilization than Whites. Over half of low-income uninsured AIANs did not have access to the IHS. However, among the low-income population, AIANs with only IHS access fared better than uninsured AIANs and as well as insured Whites for key measures but received less preventive care.

Conclusions. The IHS partially offsets lack of insurance for some uninsured AIANs, but important needs were potentially unmet.




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