Choctaw Health Center

Description

Choctaw Health Center
Mississippi Band of Choctaw Indians

Contact
Garry Batton Health Director
Mississippi Band of Choctaw Indians
210 Hospital Circle Philadelphia MS 39350
Tel 601 6562211 Fax 601 6565091

In the 1960s members of the Mississippi Band of Choctaw subsisted in miserable economic and health conditions Nearly all tribal housing was substandard 90 percent of tribal members lived in units with no plumbing and 30 percent had no electricity life expectancy was less than 50 years of age and the Tribes infant mortality rate was among the highest in the United States

At that time the Indian Health Services HIS was the primary provider of reservation health care services and spent approximately 1000 per tribal member per year on physical mental and dental health care But by the early 1970s the Choctaw tribal government determined that it would be better for the Tribe to work on its own to find solutions to its citizens health problems Over the next decade the Tribe worked consistently to contract with the IHS to take over management control of reservation health programs It obtained IHS funds to build a new hospital the 58800 square foot Choctaw Health Center in Philadelphia MS opened in 1975 and had contracted all of the IHSs public health programs some critical support services and a few direct medical care activities Still it was not until the mid1980s that the Tribe was able to take over the management of all health services On January 1 1984 the Mississippi Band of Choctaw became one of the first Indian nations to assume responsibility for the management of a complete tribal health care system

Despite this high degree of management control health conditions among the Choctaw had improved only marginally since the 1960s Health system managers pointed to funding as one of their main problems For example even though the Tribe had contracted for control of the hospital IHS funding covered only 38 percent of the communitys established need At a deeper level the problem lay in the stipulations of Public Law 93638 the act that allows tribes to contract with the federal government to take over management of service programs Under the law an existing programs budget defines the parameters of a 638 contract This restriction made it difficult for the Choctaw to create new programs and to move funds between programs in response to need or according to tribal priorities and left many vital programs underfunded

Therefore in 1994 the Tribe took the final step in breaking away from the restraints of federal government control It entered into a selfgovernance compact for all health care services and funds designated for the Choctaw Essentially selfgovernance compacts are block grants to tribes They transfer all of the federal governments budget in a particular service area to a tribe without stipulating the specific programs in which the money must be used Under a compact a tribe can set its own priorities develop its own programs and create a truly indigenous system of service provision Ideally compacts free Indian nations program planners from thinking in the same boxes that federal program developers do While there are drawbacks to compacts in particular the negotiation phase can be more difficult the Choctaw felt that having tried selfmanagement selfgovernance of health care would be an even better option

Indeed the Choctaws five years of selfgovernance over health care have built successfully on the previous two decades of selfmanagement Since compacting the Tribe has achieved tremendous strides against the health problems that have plagued community members and it has put in place a health system specifically designed to meet members needs For example the Choctaw Health Centers programs have helped to improve the Tribes immunization rate for children from 70 percent in 1990 to 95 percent in 1999 and to increase the average life span for tribal citizens which reach 68 years in 1999 With seven full time physicians and over 240 employees the Health Centers services now include a 18bed inpatient acute care unit a 24hour emergency medical services department outpatient and dental clinics a mental health center a diabetes clinic a disability clinic a womens wellness center and a variety of preventative programs

In addition to these improved and expanded service offerings the Tribe has implemented an efficient billing and records system and reduced the red tape typically associated with third party billing

The Mississippi Band of Choctaws methodical take over of federally funded health care programs and it systematic development of the Choctaw Health Center are a model of the opportunities presented by the US governments selfdetermination and selfgovernance legislation Today the Tribe not the Indian Health Service or other federal agencies calls the shots in its health care delivery system The Tribe hires the providers it chooses It contracts with offreservation providers for specialized care Choctaw children are born in stateoftheart local facilities instead of lowincome patient wards in urban hospitals and the Tribe has developed many other preventative and directcare health programs that are specifically suited to member needs Because the Mississippi Band of Choctaw Indians sets its own priorities in health care it has been able to significantly improve health conditions among its citizens a remarkable example of the effective exercise of sovereignty