This study described service use among American Indian veterans, compared use patterns across biomedical care and traditional healing options, and tested whether utilization varied as a function of need or availability.
A cross-sectional survey of 621 male combat veterans selected from tribal rolls was conducted between 1992 and 1995 in American Indian reservation communities in the Southwest and in the Northern Plains. Measures included assessments of demographic characteristics, physical and mental health conditions, and self-reports of any use during the past year of Veterans Administration (VA), Indian Health Service (IHS), and other biomedical services as well as participation in traditional ceremonies and use of indigenous healing options.
Tribal groups were similar in sociodemographic characteristics and in number of health problems and mental and substance use problems during the past year. The same types of services from IHS were available to the two groups, and the geographic distance to these services was similar. VA facilities were more readily available in the Northern Plains than in the Southwest, where they were far from reservation boundaries. Use of IHS services was similar for the two tribal groups, but use of VA services was significantly less in the Southwest. Overall, biomedical services were used more in the Northern Plains, reflecting greater use of VA facilities. However, these differences in overall health service disappeared when traditional healing options were considered. Use of traditional healing was greater in the Southwest, offsetting lower biomedical service use.
When the full array of options is examined, service use functions according to need for health care, but the kind of services used varies according to availability.