1 Includes all services on payment records other than for inpatient radiology and pathology. 2 Includes services on payment records and those using combined billing.

TABLE 8.-PROJECTED INCREASES IN RECOGNIZED CHARGES AND COSTS INCURRED PER CAPITA FOR THE AGED!

1 Increase over prior year.

2 Includes all services paid on the basis of reasonable charges except those for inpatient professional radiology and pathology.

TABLE 9.-INCURRED RECOGNIZED CHARGES AND COSTS PER CAPITA FOR THE AGED: PROJECTION

1 Includes all services paid on the basis of reasonable charges except those for inpatient radiology and pathology.

1973.

1974.

1975.

1976.

TABLE 10.-COMPONENTS OF INCREASES IN REASONABLE CHARGES PER CAPITA FOR PHYSICIAN
AND MISCELLANEOUS SERVICES 1

INDIAN HEALTH SERVICES

BASIC PROGRAM INFORMATION

LEGISLATIVE OBJECTIVE.-To meet the health needs of American Indians and Alaskan Natives.

DATE ENACTED AND MAJOR CHANGES. The provision of health services originally grew out of early treaties between the United States and Indian tribes. Legislation in 1954 transferred responsibility for Indian health services from the Bureau of Indian Affairs of the Department of Interior to the Public Health Service of the Department of Health, Education, and Welfare. Legislation in 1957 authorized the Public Health Service (now the Health Services Administration) to participate jointly with communities to furnish health facilities to Indians.

ADMINISTERING AGENCY.-The Health Services Administration of the Department of Health, Education, and Welfare, through Indian health service area projects.

FINANCING. The program is financed through fixed appropriations from general revenues of the U.S. Treasury.

The following table provides examples of the level of effort and accomplishments of the program.

Note.-Year(s) in parentheses represents base year. Data taken from Appendix, the Budget of the U.S. Government: Fiscal year 1975.

ELIGIBILITY CRITERIA

MAJOR ELIGIBILITY CONDITIONS.-Services are available to persons of Indian descent who belong to Indian communities served by the program. These communities include Indians in the Continental

United States and Indians, Aleuts, and Eskimos in Alaska. An individual is considered to be an Indian if he is regarded as an Indian by the community in which he lives, as evidenced by such factors as tribal membership or enrollment, residence on tax-exempt land, ownership of restricted property, and active participation in tribal affairs. Among eligible individuals priorities for care and treatment are determined on the basis of relative medical need and access to other arrangements for obtaining the necessary care. In order to make the most effective use of available funds and facilities, Indians who are clearly able to pay the costs of hospital care and other major items of service are encouraged to do so. In appropriate cases, services may be conditioned upon payment.

PERSONS INCLUDED.-Eligible individuals and non-Indian wives (but not husbands) of such individuals may receive benefits.

INCOME TEST. No standardized income test is applied. Whenever the medical officer in charge determines that an eligible applicant is able to pay for the needed health care without impairing his prospects for economic independence, he may be asked to do so. But the charges may be reduced or payment waived in full if, in the judgment of the medical officer in charge, the health objectives in the area served will be advanced thereby.

No charge may be made for any eligible person for immunizations, health examinations of schoolchildren, or similar preventive services, or for the hospitalization of Indian patients for tuberculosis.

ASSETS TEST. There is no formal assets test. Presumably assets are considered in the informal income test described above.

OTHER CONDITIONS

Work requirement.-There is none.

Acceptance of training or rehabilitation.—There is no requirement. Citizenship. To receive benefits, a person must be of Indian descent in a tribe resident in the United States. For further clarification see major eligibility conditions.

Residence. To be eligible for benefits, a recipient must live in an area served by the program. The Indian health program serves Federal reservations, Indian communities in Oklahoma and certain parts of California, and Indian, Eskimo, and Aleut communities in Alaska. Institutional status.-Services are available to persons in hospitals and tuberculosis sanatoriums.

Lien, recovery, or assignment.-There is no requirement.
Relative responsibility. There is no formal requirement.

BENEFITS AND SERVICES

NATURE OF BENEFITS.-Hospital care and clinic facilities are provided for the health care of American Indians, in addition to health education, sanitation, and other public health services.

Patient care.-Indians receive medical care through 51 Indian Health Service hospitals, 27 tuberculosis sanatoriums, 76 health centers, 300 health stations, or by contract with private facilities and physicians or State and local health organizations.

Field health services.-Services provided through the various outlets previously mentioned include sanitation, health education, nutrition, maternal and child health, school health, tuberculosis and other

communicable disease control, medical social services, public health nursing, oral health, family planning, and mental health.

Determinants of benefit amount.-The cash value of the benefit to the recipient is the cost to him for the medical care provided if he had obtained the services through private sources. This value is reduced by fees actually charged those patients deemed capable of paying for care.

Relationship to family size. All persons of Indian descent in a family are eligible, as are non-Indian wives (but not husbands) of Indians. The relationship between services received and family size is dependent on the medical needs of the family and how many members obtain

services.

Relationship to place of residence. To receive benefits, an Indian must live in an area served by the program. (See residence requirements above.) The variation in benefits will be dependent upon the type of facility available in the area in which the beneficiary resides.