Can Indian Health Service Referrals for Nonemergent Care Be Allocated Equitably?


This commentary responds to a case about a physician’s disappointment that a referral for nonemergent care is deferred for payment by the Purchased Referred Care Program. Jonsen et al’s 4-quadrant approach (a microethical case analysis model) is applied to suggest that deferring referrals is just only when the PRC Program operates fairly. This model, however, might inadequately account for structural inequities underlying referral care rationing by the Indian Health Service, a federal entity that is legally and ethically obligated to care comprehensively for American Indian Alaska Native patients.

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Collage of images of Black, Indigenous, and People of Color with teal, olive green, golden yellow, and burnt orange transparent overlays. Bold white text on charcoal background at the top reads
BIPOC Health Equity Library
Published on 09/27/2022
Photo of an Indigenous person holding a drum. Behind them is a scene of a lake and forested mountains.
Indigenous Knowledge Library
Published on 08/04/2022