Abstract
BackgroundExtensive health disparities exist for American Indian groups throughout the United States. Although insurance status is linked to important healthcare outcomes, this topic has infrequently been explored for American Indian tribes. For state-recognized tribes, who do not receive healthcare services through the Indian Health Service, this topic has yet to be explored. The purpose of this study is to explore how having limited access to health insurance (being uninsured or under-insured) impact American Indian women's healthcare experiences?.MethodsIn partnership with a community advisory board, this study used a qualitative description approach to conduct thirty-one semi-structured life-course interviews with American Indian women who are members of a state-recognized tribe in the Gulf Coast (United States) to explore their Western healthcare experiences. Interview were conducted at community centers, participant homes, and other locations identified by participants. Interviews were transcribed verbatim and findings were analyzed in NVivo using conventional content analysis. Findings were presented at tribal council meetings and to participants for member checking.ResultsThemes identified by participants included: (a) lack of insurance as a barrier to healthcare; (b) pre-paying for childbirth when uninsured; and (c) access to public health insurance coverage. Twenty-four women mentioned the role or importance of insurance in discussing their healthcare experiences, which was referenced a total of 59 times.ConclusionThese findings begin to fill an important gap in the literature about the health insurance experiences of American Indian tribal members. Not having insurance was an important concern for participants, particularly for elderly and pregnant tribal members. Not having insurance also kept tribal members from seeking healthcare services, and from getting needed prescriptions. In addition to promoting knowledge about, and expanding insurance options and enrollment, increased sovereignty and resources for state-recognized tribes is needed to address the health disparities experienced by American Indian groups.
Highlights
Extensive health disparities exist for American Indian groups throughout the United States
To contribute to limited knowledge in this area, we investigate how American Indian women pay for healthcare, and the impact of being uninsured or underinsured on their healthcare experiences
Only 6% of the participants in this study reported being currently uninsured, which is below national levels of American Indian groups (15%), concerns about the ability to pay for healthcare were prominent among participants
Summary
Extensive health disparities exist for American Indian groups throughout the United States. As part of treaty agreements signed between the U.S federal government and federal American Indian tribes, there exists a trust responsibility that requires the government to provide for the healthcare of American Indian populations [1] This trust agreement stipulates that the Indian Health Service (IHS) agency, run Liddell and Lilly G lobal Health Research and Policy (2022) 7:5 through the U.S Department of Health and Human Services, is responsible for providing comprehensive health services for federally recognized tribal members [2]. To our knowledge no studies have explored the topic of American Indian women’s health and insurance status—an important gap this research begins to fill by examining the experiences of American Indian women who are members of a state-recognized tribe in the Gulf South in accessing healthcare. To contribute to limited knowledge in this area, we investigate how American Indian women pay for healthcare, and the impact of being uninsured or underinsured on their healthcare experiences
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