Last year the Indian Health Service responded to dramatic changes taking place inside and outside the government. The causes for change included budget reductions, the greater and welcome involvement of American Indian and Alaska Native governments in the Indian health care system, and technological innovations.
Every year brings pressures for change.
Some pressures are more constant than others. As an example of this, almost twenty years ago I wrote a paper and identified pressures facing the Indian Health Service. I saw politics begin to play a larger role in the health care arena replacing the historic health-based focus of the Indian Health Service. Changing patterns of disease to more chronic conditions were influencing social and economic factors and the quality of life for American Indians and Alaska Natives. Today those pressures of twenty years ago still exist, but have been intensified by an environment of unparalleled federal budget reductions, the transfer of many federal programs and resources to individual states, decreases to discretionary programs in the federal budget, and the overall erosion of resources.