Tribal Self-Governance Health Care and Social Services Delivery Effectiveness Evaluation Feasibility Study: Draft Literature Review - Revised Report. IV.2.2 Quality of Care


There is little quantitative evidence on the quality of care rendered by Tribally-managed health programs and how patterns of care or outcomes may differ from health programs operated by the IHS. Although the NIHB study that was previously discussed did attempt to gather information on quality of care, quality was subjectively measured. In terms of one standard measure of quality - average wait time - 86 percent of Tribal leader respondents from compacting Tribes indicated that they had noted improvements in wait times over the 3-4 years referenced. In contrast, only 41 percent of Tribal leader respondents from contracting Tribes and 19 percent from the IHS direct service programs indicated that wait time had improved over the past years.

Tribal leaders and health directors were asked about their perceptions of the quality of care that the health systems provides to their Tribe and changes in the quality of care between 1993 and 1996. Representatives of contracting and compacting Tribes were more likely than respondents from the IHS to indicate that the quality of care had improved during this time period. Approximately 94 percent of Tribal leaders and Tribal health director respondents from contracting and compacting Tribes perceived an improvement in quality of care compared to only 62 percent for IHS direct service programs.

These findings, of course, are based on subjective perceptions. To date, no independent quantitative assessment of services provided and of quality of care and outcomes has been conducted.