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For a few years, the Indian Well being Service (IHS) has been underfunded, resulting in well being and life expectancy disparities amongst Indigenous individuals, in keeping with College of Oklahoma researchers. In an article in Well being Affairs, OU researchers suggest a novel belief fund answer to extend and maintain the funding degree, with the final word aim of bettering well being care entry and outcomes.
“IHS underfunding has been a challenge for tribal nations and the United States, and it is highly relevant to Oklahoma, which was partly founded on Indian Territory. The health of Indigenous populations in the U.S. has suffered greatly because of chronic underfunding of IHS. Indigenous people have a life expectancy of 67.9 years—a decade less than the average U.S. life expectancy,” mentioned lead creator Junying (June) Zhao, Ph.D., Ph.D., MPH, an assistant professor on the OU Hudson School of Public Well being.
“The difference in federal health care investment compared to other health programs is stark,” she added. “In fiscal year 2021, per capita federal spending for the IHS was $4,140. In comparison, the Bureau of Prisons spent $8,302; Medicaid, $8,908; the VA, $12,223; and Medicare, $15,094. For the IHS, this has meant staff shortages, outdated facilities and care that is declined or deferred.”
To boost funding, Zhao and her analysis crew suggest the creation of an IHS Belief Fund, modeled after the federal Vaccine Damage Compensation Belief Fund. Within the late Eighties, Congress made a one-time appropriation to the Vaccine Damage Compensation Fund, which has since collected excise taxes on vaccine gross sales and invested its balances. As of January 2023, the fund held over $4 billion, which is used to pay for damage claims. An IHS Belief Fund would function equally to generate ongoing monetary sources for unmet Indigenous well being care wants.
From fiscal years 2009 to 2020, the IHS was underfunded by about $60 million yearly, Zhao mentioned. To generate a $60 million annual return, about $600 million can be wanted for the baseline principal, assuming a modest 10% return charge on investments. Accounting for inflation, that quantity can be near $1 billion at this time, she mentioned.
Along with a one-time congressional appropriation to launch an IHS Belief Fund, Zhao and her crew counsel that Congress ought to grant IHS the power to just accept items. Though authorities packages sometimes can’t settle for items, Zhao believes that some entities and people have proven the power and want to contribute. There’s a precedent for IHS accepting items: About 20 years in the past, the IHS handbook included a coverage for donations.
“This approach is similar to endowments created by major universities for their capital projects,” mentioned Pallab Ghosh, Ph.D., an affiliate professor in OU’s Division of Economics and co-author of the paper. “We believe it would be good to apply this solution to the IHS budget problem as well.”
The IHS well being care system is comprised of IHS amenities, tribal-administered companies and concrete Indian amenities. Collectively, they serve roughly 2.6 million Indigenous individuals. Previous efforts to handle the underfunding downside have fallen brief. Members of Congress have twice proposed reworking IHS funding from discretionary to obligatory. Different concepts, comparable to creating a singular Medicaid program for particular person tribes, have additionally failed to realize assist.
“Since the late 18th century, the United States has had a trust responsibility to provide care in exchange for tribal lands,” mentioned examine co-author Rashmi Jaggad, MPH, MDS, analysis undertaking coordinator on the OU Hudson School of Public Well being. “But when funding is low, health care access decreases. If people cannot afford services in private care, they often must go without. That is the problem we are seeking to solve.”
Zhao and her crew have an extended historical past of conducting analysis involving underserved populations. Their work is on the coronary heart of public well being, mentioned Dale Bratzler, D.O., MPH, dean of the OU Hudson School of Public Well being.
“At the OU Hudson College of Public Health, we are committed to research that addresses real-world inequities and improves the health of all communities,” Bratzler mentioned. “This work reflects that mission by offering a creative, evidence-based solution to a longstanding issue that has impacted Indigenous people for generations.”
Extra data:
Junying Zhao, The Indian Well being Service Is Chronically Underfunded. Right here Is How To Shut The Hole, Well being Affairs (2025). DOI: 10.1377/forefront.20250827.319208
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College of Oklahoma
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Researchers suggest novel answer to U.S. Indian Well being Service underfunding (2025, October 16)
retrieved 16 October 2025
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