Research Finds Tribal Management Key to Improved Health Services
Early findings show that tribal citizens' access to health services significantly improves when health care on American Indian nations is managed by the tribes and not the federal government.

By Rebecca Ruiz-McGill, University Communications
July 24, 2009

A team of researchers from The University of Arizona's Native Nations Institute for Leadership, Management and Policy have completed the first phase of a study on the impact that tribal control of health care services has on access to quality care.


Stephen Cornell, Miriam Jorgensen, Jaime Arsenault and Stephanie Carroll Rainie, with funding from the Nathan Cummings Foundation, Morris K. Udall Foundation and the UA, set 
out to answer the following questions:

  • What happens when American Indian nations, instead of the federal government, manage health care provided on reservations?
  • Do services improve?
  • Do more tribal citizens gain access to 
health care?

The researchers interviewed more than 18 tribal, regional and national Indian leaders, health professionals and providers.

"Our early findings indicate that tribal management can significantly improve tribal citizens' access to health services," said Rainie. "But we also discovered that major challenges remain in American Indian access to health services."

Since enactment of the Indian Self-Determination and Education Assistance Act of 1975, many American Indian nations, determined to improve health conditions in their communities, have assumed control over portions – and in some cases, nearly all – of their health care delivery.

"For many American Indian nations, tribal management is an act of self-determination; the benefit is sovereignty," said Arsenault. "According to tribal members we interviewed, other benefits include increased community trust, improved retention of physicians, shorter patient waiting times and critically, increased citizen access to health service."

Under tribal management, the researchers found, tribal priorities and values more often shape the goals and methods of health programs often by integrating spiritual leaders, traditional healing practices and cultural activities into these programs.

The integrations make it more likely that native citizens will take advantage of the services, but they also identified barriers – such as personnel turnover and the shortage of Native American health care professionals.

The researchers said tribes are responding to the issues by increasing the cultural competency of non-native professionals and expanding the pool of skilled natives.

They also identified four major issues challenging tribal management of health services:


In 2003, the U.S. Commission on Civil Rights observed, "the U.S. government spends 50 percent less money on health care for Native Americans than for any other group including prisoners and Medicaid recipients." Interviewees repeatedly pointed to a lack of resources as a major barrier to enact improvements in health care services.

Tribal Governance

When tribal government is well organized, when it reflects the community's core values and when programs are sufficiently free from political interference, tribal health care management is better able to succeed.


Some tribes reported that the more successful their tribally managed clinics became, the less federal funding they received.


While American Indian nations wrestle with health care issues, including whether or not to manage the delivery of health care services, few have the time or resources to learn from the experiences of other Indian nations.

The Native Nations Institute will continue its study of tribal health care access to better understand the effect tribal control has on preventive care, successful health care strategies and how Indian nations most efficiently learn from each other's experiences and innovations.

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Udall Center