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Program Assessment


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Tribally-Operated Health Programs

Tribally-Operated Health Programs manage clinical and public health programs under Indian Self-Determination contracts and compacts. Tribes exercise self-governance and self-determination, and operate their own facilities to improve the health status of American Indians and Alaska Natives.


What This Rating Means


This rating describes a program that needs to set more ambitious goals, achieve better results, improve accountability or strengthen its management practices.
  • The programs maintain or improve the overall health of their patients each year, as measured by independent evaluations and clinical indicators. The programs have improved access rates to critical health services for a growing population. Years of productive life lost--a recognized mortality-based outcome measure, was reduced by 11% over the past decade.
  • Performance information for annual indicators is only available for programs that voluntarily report the data, or 74% of patients served in 2005. By law, tribal programs are not required to submit performance data to the Federal government or be held accountable for improving program performance. These restrictions make it difficult to identify deficiencies and improve program performance.
  • Tribes do not inform the Indian Health Service of how much funding they receive from other sources, such as Medicare, Medicaid, and the State Children's Health Insurance Program. As a result, it is difficult to determine the relationship between overall funding levels and program performance.

Improvement Plan

About Improvement Plans

We are taking the following actions to improve the performance of the program:

  • Collaborating with tribal programs to develop an approach to gather data on reimbursements from Medicare, Medicaid, and SCHIP to better understand the linkage between funding and performance.
  • Establishing an IHS/Tribal data workgroup to identify cost-effective alternatives for facility accreditation for currently unaccredited programs to ensure access to quality health care.
  • Negotiating with tribal programs to include in contracts and compacts the submission of clinical performance data to achieve a reporting rate of at least 76% of the population served by 2008.

Learn More

The content on is developed by the U.S. Office of Management and Budget and Federal agencies.