How does living on a reservation

affect the extent to which natives

receive medical treatment?
Marina Monsivais and Maya Montemayor
How does living on a reservation affect the extent
to which Native Americans receive medical
treatment?
Reservations restrict Native Americans’ access to medical treatment due to
underfunding by the government, lack of quality of facilities and doctors, and lack of
doctors in general. Through thorough research, it is evident that there are great
disparities on reservations concerning the quality of medical treatment and access to
decent medical care for natives. The negligence assumed by the government is one of
the biggest factors in the differences between the quality and access to medical
treatment for Natives living on reservations and non-natives off of reservations.
Evidence 1a
Zuckerman, Stephen et al. “Health Service Access, Use, and Insurance Coverage Among American Indians/Alaska
Natives and Whites: What Role Does the Indian Health Service Play?,” American Public Health Association,
July 17, 2003. ajph.aphapublications.org/doi/full/10.2105/AJPH.94.1.53. Accessed Feb 3, 2017.

“The federal government attempts to meet its commitment to provide health care for AIANs through a system of
hospitals and clinics on or near reservations, managed by the IHS and, more recently, by Indian tribes... However,
services available through the IHS vary widely across tribes, and IHS hospitals are not available in all service areas.
Many communities have small clinics and must contract out for all specialty care, x-ray services, and other diagnostic
tests and routine preventive care such as mammograms. Services can vary and may be limited by significant
shortfalls in funding.”
Evidence 1b
The article “Health Service Access, Use, and Insurance Coverage Among American Indians/Alaska Natives
and Whites: What Role Does the Indian Health Service Play?” superficially describes the disparities between the
quality of Native American health care on reservations and the quality of health care off reservations. The authors
support their analysis of the situation by developing a sense of how poor the health care is on reservations and by
connecting the problems to underfunding from the government. The purpose of this article is to help convey just
how bad conditions are and how the medical care on reservations came to be this way.
This source was useful in developing our understanding of the topic by outlining specific differences in
the quality of medical care on and off of reservations, and providing charts on the page that showed the actual
statistics of these differences. The article specifically described how “services [are] limited by significant shortfalls
in funding” from the government, giving us more insight as to why there are such great differences in health care for
natives and non-natives. We applied this information in our simulation, giving the non-native “Doctors” the ability
to “heal” a “Sick” person faster than the “Doctors” on the reservation to show the lack of medical resources that
Native American doctors have. In our simulation, we also had fewer “Doctors” in the Native American group to
represent the underfunding for health care professions on reservations restricts even further access to medical care
for Native Americans on reservations.
Evidence 2a
Sequist, Thomas D. et al. “Trends in Quality of Care and Barriers to Improvement in the Indian Health Service.” Journal of
General Internal Medicine 26.5 (2011): 480–486. PMC. Web. 9 Feb. 2017.
www.ncbi.nlm.nih.gov/pmc/articles/PMC3077488/. Accessed Jan 24, 2017.

“We found that primary care physicians caring for Native American patients reported suboptimal access to essential
health services to a much greater extent than physicians caring for either white or black patients. The IHS remains
significantly underfunded, receiving only about half of the funding needed to adequately care for the patients it serves.
This budget shortfall could lead directly to the type of stark resource limitations reported by the physicians in this
study... As a result, a majority (58%) of primary care physicians within the IHS report that complexity of clinical
conditions managed without specialty input was greater than it should be, compared to only 26% of physicians caring
for black and Hispanic patients. These physician reports are further substantiated by the increasing number of out-of-
network patient services denied due to lack of funding within the IHS… Despite reporting substantial challenges to
delivering care, a majority of physicians felt they were able to deliver high quality care. This divergence is likely
related to physicians defining high quality care outside of the domains of care assessed in our study.”
Evidence 2b
Thomas Sequist in the article, “Trends in Quality of Care and Barriers to Improvement in the Indian Health
Service,” investigates the trends between the government funding and the quality of facilities/amount of physicians.
Sequist supports his analysis by comparing the funding for the Indian Health Service to other funding and how this
has impacted the quality of health care facilities. The author’s purpose is to inform and influence others so that
people are more aware of the different situations people have, as well as to bring awareness to this subject in hopes
of changing the current conditions.
This was a useful source in developing our understanding and our answer to how living on reservations affects
the extent to which Native Americans receive medical treatment because we were able to see the correlation
between the government funding on reservations versus off of reservations. It also helped us to understand how the
lack of government funding had affected the amount of physicians caring for Native Americans and the quality of
facilities on reservations. We used this information in our simulation, by having an increased number of non-native
“Doctors” compared to the doctors on the Native American side in order to portray the underfunding of the IHS
(Indian Health Services).
Audience and Product
Who was our audience and why?
Our audience was 4th graders. We wanted to help teach the younger generations about the disparities between
health care on reservations versus non-natives and give them a new perspective about current conditions of
Native Americans’ lives in their own country. We chose the 4th grade specifically because they have an entire
unit about Native Americans, so the lesson fit into their curriculum.

How did we design our information specifically to reach our audience?

We gave them general facts that they would understand and put it in the form of a game; we wanted them to be
able to experience what actually goes on rather than have them read something and not fully absorb what we
were telling them.
Evidence of Product Delivery
Where and when we delivered our product:
We went to Ms. Clendenin’s 4th grade class at Casis Elementary to deliver our product on Tuesday, 2/7/17

How it was received:

The class responded positively and seemed to really enjoy our product. They were engaged the entire time
during our simulation and asked lots of questions that were relevant to our topic.

prezi.com/6gtaw_zlwehy/?utm_campaign=share&utm_medium=copy&rc=ex0share
.
Group Reflection
What we learned in the process about our topic:
● The lack of funding for health professions on reservations
● The lack of funding for facilities and equipment on reservations
● The inconsistencies of medical care and access between Native Americans living on reservations and
those who live outside of reservations.

What we would change if we were to do this again:

● Adjust the simulation…
○ To better fit the small class size (have more “Sick” people and fewer “Doctors”/ “College Students”
to make the simulation last longer).
○ To make the rules simpler, and therefore easier for a young audience to follow.

To further our audience’s understanding of this topic, we would set stricter guidelines in the simulation and
explain our findings more in depth through the game.
Works Cited and Consulted (MLA)
Berry, Mary Frances et al. Broken Promises: Evaluating the Native American Health Care System, U.S. Commission on Civil Rights,
Sept. 2004, Chapter 3. www.usccr.gov/pubs/nahealth/nabroken.pdf. Accessed Jan 10, 2017.
Berry, Mary Frances et al. Broken Promises: Evaluating the Native American Health Care System, U.S. Commission on Civil Rights,
Sept. 2004, Chapter 4. www.usccr.gov/pubs/nahealth/nabroken.pdf. Accessed Jan 10, 2017.
Braun, Kathryn L., and Cynthia LaCounte. "The Historic And Ongoing Issue Of Health Disparities Among Native Elders." Generations 38.4 (2014): 60-69. Religion and Philosophy
Collection. Web. 8 Feb. 2017. web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=5c3b4a52-f641-4d56-8f70-dea153d7c591%40sessionmgr4009&vid=4&hid=4206.
Accessed Jan 24, 2017.
“Careers in Medicine,” American Indians and Alaska Natives in Health Careers, 2006. http://aianhealthcareers.org/page1/page1.html. Accessed Jan 25, 2017.
Louwagie, Lacey. "Sioux Blame Feds for Health Care Crisis," Courthouse News, May 12 2016.
www.courthousenews.com/2016/05/02/sioux-blame-feds-for-health-care-crisis.htm. Accessed Feb 2, 2017.
McSwain, Robert. “Justification of Estimates for Appropriations Committees,” Department of Health and Human Services, 2009.
www.ihs.gov/budgetformulation/includes/themes/newihstheme/documents/FY2009BudgetJustification.pdf. Accessed Feb 4, 2017.
Rhoades, Everett R., et al. "The Health Of American Indian And Alaska Native Women, Infants And Children." Maternal & Child Health Journal 12.(2008): 2-3. Academic Search
Complete. Web. 8 Feb. 2017. web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=4f78b460-64be-4952-9690-5a4c1f3615b6%40sessionmgr102&vid=4&hid=116. Accessed
Jan 26, 2017.
Rogers, Deborah, and Daniel G Petereit. "Cancer Disparities Research Partnership In Lakota Country: Clinical Trials, Patient Services, And Community Education For The Oglala,
Rosebud, And Cheyenne River Sioux Tribes." American Journal Of Public Health 95.12 (2005): 2129-2132. MEDLINE. Web. 8 Feb. 2017.
web.b.ebscohost.com/ehost/detail/detail?vid=6&sid=9373dd01-83e2-433f-9e9a-5e2f0d708e42%40sessionmgr101&hid=116&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%. Accessed
Jan 24, 2017.
Sequist, Thomas D. et al. “Trends in Quality of Care and Barriers to Improvement in the Indian Health Service.” Journal of General Internal Medicine 26.5 (2011): 480–486. PMC. Web.
9 Feb. 2017. www.ncbi.nlm.nih.gov/pmc/articles/PMC3077488/. Accessed Jan 24, 2017.
Zuckerman, Stephen et al. “TABLE 2—Health Care Access and Utilization of Whites and American Indians/Alaska Natives: National
Survey of America’s Families, 1997 and 1999,” American Public Health Association, July 17, 2003, Table 2.
http://ajph.aphapublications.org/doi/full/10.2105/AJPH.94.1.53. Accessed Feb 3, 2017.