EXECUTIVE SUMMARY

**[Overview Of The Budget]{.underline}**

This budget request and performance plan support the provision of
essential primary care and public health services to American Indians
and Alaska Natives. The request of 2,967,272,000 in budget authority is
an increase of \$45,558,000, which represents a 1.6 percent increase
over the FY 2004 enacted level. At the Program Level, the budget request
is \$3,715,934,000.

**[Policy Basis For FY 2005 Budget Request]{.underline}**

The Federal commitment to raise the health status of American Indians
and Alaska Natives in partnership with Tribal governments is
longstanding. The HHS and IHS Strategic Plans provide the framework for
carrying out this commitment. The HHS Plan outlines the broad goals for
improving the health of all Americans while the IHS Plan describes in a
more detailed fashion the actions necessary for achieving the HHS
objectives for the American Indian and Alaska Native population
specifically. These budget requests support programs and activities that
contribute to all of the HHS Strategic Goals, which encompass the four
IHS Strategic Goals to: (1) Build Healthy Communities, (2) Achieve
Parity in Access by 2010, (3) Provide Compassionate, Quality Health Care
and (4) Embrace Innovation.

# Tribal Consultation

Consistent with Presidential Executive Order 13175, Tribal and Urban
Indian health program representatives were consulted during the
formulation process of this budget request. Throughout the process
funding of increases such as pay raises, inflation, etc., has been the
priority as the means of protecting the current level of services that
are provided by IHS, Tribal, and Urban (I/T/U) programs. Beyond these
current services increases, greater funding of prevention activities was
expressed as a critical element of success for addressing the most
pressing health problems in the American Indian and Alaska Native
population. This budget responds to these priorities of the Tribal and
Urban Indian health programs.

**[Budget Priorities And Strategies]{.underline}**

The underlying strategy of this budget request is to address increased
costs in order to assist the I/T/U health programs to maintain access to
basic health services and boost efforts to prevent disease/illness. The
budget proposal supports the President\'s Healthier US initiative,
focusing on improving the health and wellness of American Indians and
Alaska Natives.

The IHS has demonstrated the ability to effectively utilize available
resources to improve the health status of the American Indian and Alaska
Native people, although progress is jeopardized by a growing service
population and increases in the cost of providing health care. To
address the maintenance of access to essential individual and community
health services, the budget request includes \$59.3 million for pay
costs and staff for newly opened facilities. Program increases of \$39
million are included to support community health promotion/disease
prevention efforts, expand the capacity of Tribal epidemiology centers,
and provide more homes with safe water and sewage disposal. Funds are
included to complete health care facilities construction projects
underway, with the total funding level decreased by \$52.8 million from
FY 2004.

**[Anticipated Outcomes]{.underline}**

This budget will allow I/T/U programs to continue providing health care
to American Indian and Alaska Native patients in the same manner as the
previous year. Although the I/T/U programs face a growing service
population and increases in the cost of providing health care, they are
committed to their patients and make every effort to avoid reductions in
services. This commitment is reflected in the clinical GPRA performance
targets which are set at maintaining the proportion of the population
served. These targets are more challenging than they seem. To maintain
the proportion of the population served actually means increasing the
number of services provided in order to accommodate the growth in the
population. The resulting effect is to ensure that health status does
not decline.

This budget will also allow the IHS to strengthen its infrastructure and
capacity to support community and clinic-based prevention programs and
collect and manage health care data more effectively. From these
activities, the I/T/U programs will gain a better understanding of the
link between public health problems and behavior, socioeconomic
conditions, and geography.

At the program level, it is anticipated that the Special Diabetes
Program for Indians (SDPI) grantees who are focusing on secondary and
tertiary prevention geared at reducing diabetes complications will
continue demonstrating success. The SDPI has already demonstrated a
clear trend of improvement in the services that are provided to diabetic
patients. In fact, the I/T/U system has already far exceeded the Healthy
People 2010 target of 50% for annual HgbA1c screening. In addition,
there has been a steady increase in the percent of American Indian and
Alaska Native diabetic patients whose HgbA1c is less than 7.0
(reflecting ideal blood sugar control). Continued improvements in these
performance indicators reflecting secondary and tertiary prevention
efforts will reduce the morbidity and mortality associated with
diabetes.

**[Program Assessment Rating Tool (PART) Summary]{.underline}**

The FY 2004 programs that were rated using the PART were the IHS
Federally Administered Program, which received a score of 77, and the
Sanitation Facilities Construction Program, which received a score of
80. The IHS programs that are included in the PART assessments for FY
2005 are the Urban Indian Health Program (UIHP) and the Resource and
Patient Management System (RPMS), which is the information management
system that supports patient care in a majority of settings across the
Indian health care system. The final RPMS PART rating is 88. The UIHP
PART rating is 69.

The budget request reflects these scores by proposing increases in
several areas where the PART evaluations have confirmed that investment
is warranted. The current services increases reflect this assessment as
well as the program increases for Health Promotion/Disease Prevention,
Contract Health Services, the Unified Financial Management System, and
Sanitation Facilities Construction.