American Indian Culture and Research Journal

American Indians and Alaskan Natives greeted the passage of the self-determination legislation of 1975 with cautious optimism. The law gave tribes and tribal organizations the ability to contract for the management of health care and other services previously managed by agencies of the federal government. The doctrine that motivated this shift toward increased Indian self-sufficiency determined that tribes would be more responsive to the needs of Indian people than the federal government bureaucracy. However, the law included many financial barriers to tribal management. Moreover, after years of being excluded from management decisions, many tribes lacked the resources necessary to manage these services successfully. Given these impediments and the continued under-funding of Indian health, some tribal leaders began to view the legislation as a way to rid the federal government of its obligations to American Indians once and for all. This study explores the tribal and environmental characteristics that may influence a tribe’s decision to switch to tribally managed health care resources. The findings of this study suggest that inadequate responsiveness by the local Indian Health Service (IHS), as measured by a lower percent of American Indian managers and fewer appropriations at the area level, is a crucial determinant in switching to tribal management. The issue of inequity in the responsiveness of IHS area offices and how it affects a tribe’s ability and desire to manage health care resources deserves further consideration.