Health Differences Among Lumbee Indians Using Public and Private Sources of Care Alfred Bryant, Jr., PhD; 1 R. Turner Goins, PhD; 2 Ronny Bell, PhD; 3 Richard Herrell, PhD; 4 Spero M. Manson, PhD; 5 and Dedra Buchwald, MD 6 ABSTRACT: Context: Of 2.4 million American Indians, approximately 60% are eligible to receive Indian Health Service (IHS) benefits, leaving many to seek care elsewhere. It is unknown if their quality of care, health behaviors, and health status vary by source of care, as demonstrated for other populations. Purpose: The purpose of this study was to determine whether preventive services, health behaviors, and number of health conditions vary as a function of having non-IHS public versus private physicians as sources of usual care. Methods: 1,177 Lumbee Indians, who are ineligible to receive IHS services, completed a telephone interview that included information on receipt of preventive measures, tobacco use, physical activity, breast self-examination, and medical conditions. Frequencies, chi-squares, t tests, odds ratios, and confidence intervals were used to compare variables by source of care. Findings: 939 respondents (80%) had a private and 210 (18%) a public health clinic physician as their usual source of care; 28 (2%) reported having neither. Logistic regression analyses, restricted to the 1,149 participants who reported either a private or public source of care, revealed no differences in receipt of preventive services or health status by usual source of care. Smokeless tobacco use was less common among persons using private than public providers. Conclusions: Lumbees whose usual source of care was a public clinic physician did not differ in receipt of preventive services or in health status compared to their counterparts who received care from a private physician. More targeted research into health similarities and differences arising from access to public and private sources of care is warranted. A merican Indians are one of the fastest growing segments of the US population. 1 However, of 2.4 million American Indians, only 60% are eligible for Indian Health Service (IHS) benefits, leaving many to seek care elsewhere. Factors influencing this process are of special interest as the health status of American Indians falls well below that of the majority population. 2 Despite obvious need, health care use among American Indians remains relatively unexamined. 3 Past research suggests preventive services, health status, and health behavior can differ as a function of one’s source of care. 4-7 Many health conditions that affect American Indians can be prevented or detected early and treated effectively. 8 However, American Indians, whose overall use of health services is significantly less than the general population, 9 appear at special risk for not receiving appropriate care. 10 Understanding the significance of non-IHS public versus private sources of care, and implications for quality of care received, represents an important step 1 School of Education, University of North Carolina at Pembroke, Pembroke, NC. 2 Center on Aging and Department of Community Medicine, School of Medicine, West Virginia University, Morgantown, W Va. 3 Public Health Sciences, Wake Forest University School of Medicine. 4 National Institute of Mental Health, National Institutes of Health, Bethesda Md. 5 American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Aurora, Colo. 6 Department of Medicine, University of Washington, Harborview Medical Center, Seattle, Wash. Supported by grant P30 AG15297 from the National Institute on Aging (S.M.M. and D.B.), grant P01 HS10854 from the Agency for Healthcare Research and Quality (S.M.M. and D.B.), grant P60 MD000507 from the National Center for Minority Health and Health Disparities (S.M.M. and D.B.), United Way/Bowman Gray Venture Funds, Wake Forest University School of Medicine (R.B.), and grant R03 DK54863 from the National Institute of Diabetes and Digestive and Kidney Diseases (R.B.). For further information, contact: Dr. Spero M. Manson, American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Nighthorse Campbell Native Health Building, Room 322, Mail Stop F800, PO Box 6508, Aurora, CO 80045-0508; e-mail spero.manson@uchsc.edu. ..... Health Services: Native Populations ..... Bryant, Goins, Bell, Herrell, Manson and Buchwald 231 Special Issue/Summer 2004