Delineation: An Overview of the Policy under Analysis

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I. Delineation an Overview of the Policy under Analysis
What is this specific policy or general policy area to be analyzed? Warne, D. (2007) states that there are many injustices within the “system” ,but Health Care Policy; which determines who gets health services, what those services are and how those services are delivered and Education Policy which determines who gets educational programs, what those programs are and how those programs are administered are among the highest needed policies that need attending to.
What is the nature of the problem being targeted by the policy? There are two factors that influence the nature of the problems at hand. The two key differences that exist between health policy and education policy for American Indian and Alaskan Native (AI/ANs) are first, healthcare is not a legal right in the United States (US), whereas everyone has a right to public education through high school. In the US individuals are not born with a legal right to healthcare services. Typically, citizens of the US either have enough resources to pay for health services/health insurance or they are impoverished enough to qualify for public assistance (e.g., Medicaid programs) Warne, D. (2007).
What is the context of the problem being analyzed (i. e., How does this specific policy fit with other policies seeking to manage a social problem)? According to the US Commission on Civil Rights (2004), per capita expenditures in the 2003 federal budget for AI/AN people receiving healthcare services from the IHS were $1,914. In contrast, the per capita medical expenditure for Medicaid recipients was $3,879, for Medicare recipients was $5,915, and, for Veterans Administration beneficiaries, the per capita expenditure was $5,214.
The per capita medical expenditures for federal inmates in the Bureau of Prisons was $3,803 – nearly double the per capita medical expenditure for American Indians. Limitations in funding and historically inadequate third-party billing have led to decreased access to healthcare services for the AI population. Figure 1 shows per capita funding for several federally funded health programs.

Figure 1. Comparison of per capita healthcare expenditures for several federally funded healthcare systems in US dollars [Indian Health Service (IHS), Bureau of Prisons, Medicaid, Veterans Administration (VA), and Medicare]. Figure adapted from US Department of Health and Human Services, Indian Health Service, January, 2006.
The second key difference between health policy and education policy is access to third party sources of revenue. Since IHS and tribal health programs are underfunded, and since significant numbers of AI/ANs are impoverished, IHS and tribal health programs have become dependent on third party revenue from several sources, primarily Medicaid.

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