Reforming the Indian Health Service
By Rep. Kristi Noem
For years, federal reports have documented shocking cases of mismanagement and poorly delivered care within the Indian Health Service – more often referred to as the IHS. The agency was left to make improvements on its own, but even with consistent funding increases, it produced an unacceptable level of care.
Babies have been born on bathroom floors and with no doctor present. Surgical equipment has been washed by hand. Staff have interacted with patients even though their certifications have lapsed. Even now, years after many of these problems were identified, some IHS hospitals in South Dakota continue to run afoul of basic care standards, with one facility facing the loss of critical financial support just over a month ago because of the poor levels of care being delivered. Nowhere in the world is this kind of care acceptable – especially not in our backyards.
This May, I introduced the Restoring Accountability in the IHS Act, which fundamentally changes how the IHS operates. At its core, this legislation is about putting patient care first.
In many cases, improving care begins with recruiting better medical staff and hospital leadership. Most IHS facilities in South Dakota are located in remote areas and the incentives to move there – let alone relocate one’s family there – haven’t been adequate. My legislation provides stronger incentives for new hires, including relocation reimbursements when employees move to high-need areas and an expanded student loan repayment program. The bill also works to take advantage of volunteer labor, removing some of the barriers that currently inhibit medical professionals from volunteering at an IHS hospital or clinic. And when it comes to firing employees who fail to support the patients they’re there to serve, we give the IHS greater authority to do so.
Beyond hiring and firing, the Restoring Accountability in the IHS Act aims to improve patient care through greater oversight. That means new standards for timeliness of care, restrictions on bonuses, and reporting requirements to help identify staffing needs, measure patient care, and detect any misuse of funds.
Enough is enough. We need to move swiftly, yet deliberately, with these reforms. I’ve been working very closely with my counterparts in the Senate to advance the Restoring Accountability in the IHS Act through both chambers at the same time. I’m hopeful this will help streamline the process and enable us to get President Trump a bill sooner.
Lives have been lost because of what’s happening. Big adjustments need to be made – and they need to be made quickly. I’m committed to this process and to working together to ensure tribal members receive the care their families need.
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Perhaps we should consider the fact that government just isn’t very good at delivering healthcare. A private hospital or healthcare organization is forced to react to market pressures and if a certain organization is providing poor health care, that organization would be forced to make some quick changes or risk being out of business.
In its current structure, IHS never has to worry about going out of business. That becomes problematic because there are no real consequences to providing poor healthcare. Perhaps instead of greater government oversight of IHS, there should be some thoughtful consideration to privatizing the care given to our our indigenous people. Maybe IHS should become more of a payor source rather than healthcare provider and allow patients to seek out and choose their own provider based on their own preferences. Let the free market sort it all out with the current government oversight in place for healthcare providers and organizations.