Health Care Overview: the I/T/U

The federal government provides health care for Indian people as part of its trust responsibility, through a network of tribal, federal, state, local, and nonprofit programs, as well as entities composing the Indian Health System. This system has three major components, collectively referred to as the I/T/U:

  1. Indian Health Service (IHS): A federal agency that operates clinics and other facilities to provide direct patient care, advocates for the health of AI/ANs within the federal government, and provides funding to tribal health services managed by tribes, including Urban Indian Health Programs.
  2. Tribal health services: Health care programs managed by tribes with funding from IHS.
  3. Urban Indian Health Programs: A total of 33 nonprofit urban Indian organizations that provide health care to Indian people who live in cities.

Through IHS, the federal government funds all three of these components. However, federal funding is far from sufficient to meet the health needs of Indian people, who continue to have the highest health disparities of any population in the United States. It is also less per capita than for other federal health care systems, such as for prisoners.

Many Indian individuals receive care funded and provided through a patchwork of these different entities, combined with other private and government providers, such as employers.

The intersection of these systems is incredibly complex and the administrative burden is heavy for individuals, providers, and administrators.