Tribal Self-Governance Health Care and Social Services Delivery Effectiveness Evaluation Feasibility Study: Draft Literature Review - Revised Report. I.1 Overview


The Tribal Self-Governance Evaluation Feasibility Study, being conducted by Westat, and its subcontractors, Project HOPE Center for Health Affairs and Kauffman and Associates, Inc., will provide the Office of the Assistant Secretary for Planning and Evaluation (OASPE) with background information and a detailed review of issues, data availability, and data systems that may affect the extent to which a rigorous and defensible evaluation of Tribal Self-Governance of Indian Health Service and other non-IHS programs can be conducted. While a number of assessments of Tribal self-governance programs have been conducted, these have been primarily qualitative in nature. OASPE is interested in determining the feasibility of conducting an evaluation that examines processes and program changes associated with successful self-governance programs, as well as impacts of Tribal self-governance on outcomes, including access to care, services, quality, costs, financial performance and resources, customer satisfaction, and program stability.

This Draft Literature Review represents one component of the background information that is being assembled to provide a foundation for the development of the evaluation issues, and related data requirements, that will guide that design of the feasibility study. The objectives of this literature review include:

  • Discussion of data limitations and other factors that pose barriers to conducting comprehensive evaluations of self-governance and Tribal management of health and social service programs.
  • Overview of issues and research questions that might be addressed in a comprehensive evaluation of self-governance and Tribal management of health and social service programs.
  • Identification of existing studies and evaluations of Tribal self-governance and/or Tribal management of health and social service programs;
  • Review of the methodologies and data sources used in previous studies, in order to assess both analytic rigor and generalizability of their findings;
  • Synthesis of the available evidence and findings from existing studies; and
  • Assessment of the implications of these findings for the Tribal Self-Governance Evaluation Feasibility Study.

In the next section of this Draft Report, the background and definition of Tribal self-governance and Tribally-managed programs are reviewed and a list of the relevant health and social services programs for the literature search and review is provided. Then, a discussion of data limitations and other factors that make comprehensive evaluation of Tribal self-governance and management of health and social service programs challenging is presented in Section III. Sections IV and V present a summary and assessment of the literature on Tribal self-governance/management of health programs and of social programs, respectively. Section VI discusses the implications of the findings from the literature review for the design and approach to the Tribal Self-Governance Evaluation Feasibility Study. Appendix A to the Draft Report briefly describes the literature search methods that were used to identify relevant published and unpublished studies. Appendix B contains a complete bibliography of sources identified and reviewed for this Report.