Urban Indian Health Clinics, Funding Issues, and Their Effects on Decision Making

The purpose of the sequential triangulation mixed methods study was to explore the effects Indian Health Service (IHS) government funding cuts of 30% or higher might have on decision making in the areas of access, quality, and cost for urban Indian clinics in the San Francisco Bay Area. The study involved assessing the opinions of Indian health care leaders in an effort to gain an understanding of the potential impact of future IHS budget cuts on the Native American population in the Bay Area. The study findings revealed that a significant cut in IHS funding would affect access to high demand programs and services as well as programs and services with a high level of cultural significance. In response to a significant cut, the urban Indian clinic would focus on other revenue prospects or restructure organizational services using a lower budget. Any significant disruption in access would cause urban Indian patients to either travel to other community clinics for services or to stop using the clinic's health care services altogether. The study findings indicated that a potential cut of 30% or higher in IHS governmental funding to urban Indian clinics would affect the quality of health care at the local urban Indian clinic. A significant cut in IHS funding would force the clinic's leadership to cut staff or providers, limit the amount of time spent with Indian patients, or recruit less qualified staff or providers. Despite any action taken by the clinic's leadership, the clinic must always provide high quality services. The findings indicated that potential cuts of 30% or higher in IHS governmental funding to urban Indian clinics would affect the cost of health care at the local urban Indian clinic. A significant cut in IHS funding would cause the leadership to focus on other revenue prospects, cut transportation services, increase patient out-of-pocket expenses, or cut free programs or services. An increase in cost might cause urban Indian patients to relocate to native reservations in response to an increase in out-of-pocket expenditures at the local urban Indian clinic or to stop using the services altogether.