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Publication Briefs

Study Suggests Disparities in Healthcare Coverage and Access among American Indian/Alaska Native Veterans


  • American Indian/Alaska Native (AIAN) Veterans have considerable disparities in healthcare coverage and access to care compared to non-Hispanic white Veterans. For example, AIAN Veterans are nearly twice as likely to be uninsured, even after adjusting for sociodemographic and economic characteristics.
  • AIAN Veterans are significantly less likely to report private coverage and significantly more likely to report public coverage, military coverage, and be uninsured.
  • Regarding barriers to healthcare, AIAN Veterans were significantly more likely to delay healthcare due to not getting timely appointments, not getting through on the telephone, and having transportation problems.

While the Indian Health Service (IHS) plays an important role in providing access to healthcare for American Indian/Alaska Native (AIAN) Veterans who reside on or near reservations, many AIAN Veterans reside in urban areas or other places not served by the IHS. Moreover, the IHS is underfunded, which has led to rationing of healthcare even among eligible Veterans. This study examined healthcare coverage and disparities in access to healthcare for AIAN Veterans compared with non-Hispanic white Veterans. Using data from the National Health Interview Survey (1997-2006), investigators identified 34,504 AIAN and white Veterans ages 18 to 64. Investigators then examined healthcare coverage - private, public (e.g., Medicaid, Medicare), and military/VA, as well as access to care and sociodemographics (e.g., gender, age, education, employment, region of residence). Although access to IHS is reported, IHS alone was not considered health insurance coverage. Beginning in 1998, respondents reporting access to IHS but not to any other insurance were universally considered uninsured by federal agencies conducting surveys on health insurance.


  • The survey used in this study excludes active duty military personnel, and includes only honorably discharged Veterans by self-report.
  • National surveys more often include AIAN Veterans from urban areas who may be systematically different than AIAN Veterans residing on reservations or in rural settings.

In 2003, IHS and VA signed a memorandum of understanding to "encourage cooperation and resource sharing" and "to deliver quality of health care services and enhance the health status of American Indian and Alaska Native Veterans." Implementation of these collaborative efforts is underway, but there are still Veterans who do not access services through either VA or IHS. This study provides a population perspective on access disparities that includes this latter group.

Dr. Carlson is part of HSR&D's Center for Chronic Disease Outcomes Research in Minneapolis.

PubMed Logo Johnson P, Carlson K, and Hearst M. Healthcare Disparities for American Indian Veterans in the U.S.: A Population-Based Study. Medical Care June 2010;48(6):563-69.

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