CHALLENGES TO NATIVE-AMERICAN HEALTH-CARE

NATIVE AMERICAN HEALTH CARE is facing challenges that are unprecedente d in its history. External forces are intensifying those challenges; t hree are particularly powerful. (a) the gradual but accelerating assum ption of responsibility for delivery of clinical services by tribal go vernments and the concomitant decrease in direct U.S. Indian Health Se rvice (IHS) operational responsibility; (b) resource constraints resul ting from Federal appropriations insufficient to cover inflationary co sts and thus not capable of sustaining levels of services, particularl y during the 1990s;(1) and (c) the growth of managed cave and increasi ng interest by managed care organizations in contracting with tribes f or delivery of clinical services.