Defining Community-Based Health Care in Navajo Area
Tuba City Regional Health Care Corporation, Tuba City, Arizona
Utah Navajo Health System, Inc., Montezuma Creek, Utah
Winslow Indian Health Care Center, Inc., Winslow, Arizona
A new era in Native American healthcare in Navajo Area began on April 19, 2002, when the Navajo Nation Council approved a special pilot project for three Navajo non-profit healthcare corporations
After five years of planning, the Tuba City Regional Health Care Corporation (TCRHCC), in Tuba City, Arizona, the Utah Navajo Health System, Inc. (UNHS), in Montezuma Creek, Utah, and the Winslow Indian Health Care Center, Inc. (WIHCC), in Winslow, Arizona, were authorized by the Navajo Nation to negotiate contracts with the Navajo Area Indian Health Service (NAIHS) to deliver healthcare, previously under the administration of the Indian Health Service (IHS), and agency within the federal Department of Health and Human Services.
This set the stage for local control at each of the three corporations, which would be governed by local boards comprised of community members. Decision-making authority was effectively shifted from U.S. government control to the community level. Self-Determination brought decision-making about budgeting, spending, personnel, services and facilities to the community level. Each of the local healthcare corporation have access to the resources of IHS, and are also free to seek additional revenues and funds from third party sources for the first time. Local boards of directors are better acquainted with the needs of the local communities. New programs and purchases can be initiated more expeditiously.
The availability and improvement of healthcare is one of the single most important issues confronting Native Americans today. Only through Self-Determination in healthcare will Native Americans achieve true healthcare equality with other Americans.
Winslow Indian Health Care Center CEO Sally Pete commented, “Self-Determination initiatives and activities began at WIHCC on April 19, 2002, when the Navajo Nation Council approved Winslow as one of the Self-Determination pilot projects. Despite the long, difficult processes, preparing and negotiating with the Indian Health Service paid off.”
“The private enterprise ideology allows the Self-Determined corporations to develop and improve programs, facilities, and additional funding resources much more quickly than the IHS federal system,” said Donna Singer, CEO at UNHS. “Local input and governance for healthcare is very effective in meeting the needs of the people.”
“The impact of Self-Determination on healthcare on the Navajo Nation has been very positive. Each Self-Determined contractor has moved forward with more financial stability, a significant increase in services and service sites, and are working on remodeling or replacing major facilities using private enterprise and IHS strategies,” continued Singer.
Advantages of Self-Determination
Distinctions between working through federal government agencies versus Self Determination:
Through Government: Funding is limited to government appropriations only. There are lengthy “red tape” processes for all procurement and capital improvements. The system delays progress and increases administrative costs at the expense of healthcare services.
In Self-Determination: Federal, state and private grants and other funding resources are available. Self-Determination corporations are able to respond more quickly and effectively to community healthcare needs, with both services and facilities.
Through Government: Patient services are limited by inadequate federal funding that requires prioritizing healthcare needs. All decisions are directed by federal processes. Issues arise at the local level, with decisions made at the federal level.
In Self-Determination: Service availability is not determined solely by government resources. Needs assessments are done at the community level to determine the need for services, facilities and programs.
The Association of Indians for Self-Determination in Healthcare
The three Navajo Self-Determined healthcare corporations have formed The Association of Indians for Self-Determination in Healthcare.
Mission Statement: To provide a strong, unified, organized representation for Self-Determination advocacy in development and implementation of healthcare policies affecting programs and funding on a local, tribal, regional and national level.
Board members and administrators of the member corporations meet on a periodic basis to collaborate, present updates of the activities of each corporation, and discuss issues that impact the best delivery of care to their respective communities.
All three Navajo Self-Determined corporations are on firm financial footing and have consistently received clean audits by independent auditing firms.
Self-Determination – IHS and More
For the Native people of the United States, health services are guaranteed. In choosing Self-Determination, an Indian healthcare corporation is governed at the local level, and contracts with IHS for a portion of its funding, but the corporation is no longer under the control of IHS. IHS and other federal agencies are charged with supporting the local communities in their choice, and to assist them in a successful transition.
Through Self-Determination, local jobs are created. Local control allows the corporation to determine its own staffing needs, advertise for positions, and make hiring decisions.
The contracts with IHS specifically provide for the sovereignty of the contracting tribe. The contract states, “Nothing in this contract may be construed to terminate, waive, modify or reduce the trust responsibility of the United States.” The sovereignty of the tribe is strengthened.
To improve on the healthcare previously delivered by IHS, the Self-Determined corporations are free to seek additional funding from other sources – federal and state sources, foundations, grants, and private insurance coverage. Formerly, when there were IHS budget cuts, operations were directly affected. A Self-Determined corporation has many options for making up any reduction in IHS funding from third parties. Federal law specifies that an IHS contract cannot be reduced because of a corporation’s success in obtaining other funding.
“All three Self-Determined facilities are focusing on bring more health services to the local communities to improve access to healthcare for the Native people,” said Singer. “These units are working to support each other and with the NAIHS and the Navajo Nation Department of Health to develop stronger healthcare delivery systems.”
Tuba City Regional Health Care Corporation
The Tuba City Regional Health Care Corporation (TCRHCC) is a 73-bed, acute care facility, an outpatient clinic, and a regional referral medical center with emergency room services. It was recently designated as a Level IV trauma center and is a pivotal hub in the newly formed Western Navajo Regional Trauma System. The trauma system is organized to more effectively save lives. TCRHCC is the first designated trauma center on an Indian reservation in the United States.
TCRHCC was incorporated as a private, non-profit healthcare organization under Self-Determination on September 30, 2002. The main TCRHCC campus is in Tuba City, with a satellite clinic for expanded dental services in Cameron, Arizona, and a small health clinic in Dinnebito, Arizona, at the eastern edge of the Hopi Reservation. As a regional referral medical center, TCRHCC provides both inpatient and outpatient advanced diagnostics and clinical services. Many state-of-the-art services have been added with investments in modern clinical equipment. TCRHCC is at the forefront of medicine for Native America. The staff numbers approximately 775 individuals. The current operating budget is $95 million per year.
The TCRHCC health system provides over 55 clinical and 36 support department services, including several hundred types of patient diagnostic and treatment procedures.
TCRHCC’s Health Promotion and Disease Prevention (HPDP) program reaches out to communities across the service area with primary prevention programs for asthma, diabetes, obesity and tobacco cessation, as well as nutrition education and exercise programs.
TCRHCC physicians provide specialty clinics at neighboring health centers and schools each month.
Recent renovations and additions include a 24-hour Refill Pharmacy, recently opened to serve the needs of patients who receive routine monthly prescription refills. By calling in for a refill 24 hours in advance, waiting time is virtually eliminated.
A state-of-the art MRI unit was installed and made operational in the summer of 2009, making TCRHCC the only Indian health unit aside from Alaska to have in-house MRI capabilities.
Patient utilization in fiscal year 2008 at TCRHCC was as follows:
Outpatient/Primary Care
- Primary Care visits: 251,623
- Emergency visits: 24,267
- Dental care visits: 21,254
Inpatient Care
- Inpatient admissions (adults & pediatrics): 3,659
- Hospital days (adults & pediatrics): 12,439
- Obstetrical deliveries: 508 births
- Surgical cases: 3,153
The TCRHCC Board of Directors is a ten-member governing body, with one representative each from the Navajo chapters of Bodaway-Gap, Cameron, Coalmine, Coppermine, Kaibeto, LeChee, Tonalea, and Tuba City; one representative from the Hopi village of Moencopi; and one representative from the San Juan Southern Paiute Tribe.
TCRHCC is accredited by the Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The Joint Commission is the nation’s predominant standards-setting and accrediting body in health care.
TCRHCC was formerly known as Tuba City Indian Medical Center (TCIMC), a unit of IHS.
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