The University of Oklahoma Center for Indian Tribal Policy Research recently released a new Sovereign report titled “Purchased/Referred Treatments and Cancer: Overview and Options for Tribal Considerations.”
The report, written by Grace Fox (Seminole), the center’s tribal health policy analyst, examines how the Indian Health Service’s Purchasing and Referral Care (PRC) program interacts with cancer screening, diagnosis, treatment, and follow-up for eligible tribal members.
PRC is a program by which the Indian Health Service (IHS) approves and pays for eligible care provided by non-IHS or non-tribal health care providers when services are unavailable or inaccessible locally. This report provides an overview of China’s structure, eligibility requirements, notification schedules, priority levels of care, alternative resource arrangements, and funding constraints.
“Our work at the Native Nations Center is first and foremost about tribal leaders and their communities,” Fox said. “This report aims to provide clear and accessible information about how the Indian Health Service Purchase/Referral Treatment Program works in practice and where delays and gaps are most likely to occur, particularly in cancer care.”
This report highlights that cancer is an increasingly urgent public health priority in India. American Indians and Alaska Natives receive later diagnoses, have lower participation in screening, and have higher mortality rates than the overall U.S. population.
“When someone faces a cancer diagnosis, timing is important,” Fox said. “Purchase/referral treatment programs often serve as a bridge to specialty oncology services that are not available locally. Understanding the process from referral to authorization to payment can make a meaningful difference for patients and tribal health systems.”
This report is based on national data and federal regulations, but also includes information specific to Oklahoma. Oklahoma is home to more than 39 tribal nations, 38 of which are federally recognized tribes. All 77 districts in the state have been designated as purchased and referred care delivery areas under Indian Federal Health Service guidelines. Even with statewide purchased and referred care delivery area status, individuals must meet all eligibility, documentation, and funding requirements for program authorization.
Fox said the final section of the report outlines policy options tribes can consider under the current system, including self-determination and autonomous authorities, regional cooperation, and service delivery models such as mobile screening and teleoncology. Teleoncology uses telemedicine technology to provide cancer treatment services. This section also addresses care coordination and navigation and sovereign-driven federal engagement avenues.
Mr. Fox’s position as Tribal Health Policy Analyst at the Native Nations and Tribal Policy Research Center was created as a collaboration between the Center and the Native American Cancer Health Equity Center at the Stevenson Cancer Center. This project was funded by an Improving Cancer Outcomes in Native American Communities (ICON) grant as part of a larger effort to transform health-related research and policy in tribal communities. This report was developed in light of grant efforts and reflects ongoing discussions among researchers, clinicians, and community partners working to address cancer disparities in tribal communities. A rigorous review process by the Center for Indigenous and Tribal Policy Research required incorporating the interdisciplinary expertise of several members of the Cancer Health Equity Team.
Fox said the report has already expanded beyond its initial target audience of tribal leaders and is attracting the attention of clinicians, researchers and health care partners in Oklahoma and across the country. He said an ICON grant supported in Congress by U.S. Rep. Tom Cole helped make this effort possible, and he began conversations with health leaders and policymakers in Washington, D.C., about how China’s policies impact access to cancer treatment in tribal communities.
This work is nonpartisan research and policy analysis that supports tribal decision-making, but is shaped by personal experience.
“It reminds me of my mother, who was diagnosed with cancer this time last year,” Fox said. “Seeing her life experiences and struggles, I knew that every moment was of the essence, so I did not have time to seek medical attention in the Indian Health Service because of the time it would take.
“That in itself shines a light on the challenges that exist,” Fox said. “This shows why tribes and tribal populations can benefit from having more information and improved pathways to care.”
But Fox pointed out that the report is not prescriptive. “We are not telling tribes what to do. We are providing research-based analysis and options for consideration that tribes can evaluate within their own governance structures and priorities.”
In addition to Fox, the Native Nations Center is comprised of Research Project Manager Evelyn Cox (Chamoru), Vice President of Tribal Relations Tana Fitzpatrick, JD (Lakota/Crow/Ponca/Chickasaw), and Administrative Manager Quanah Yazzie (Navajo). They work continually to provide research findings to tribal leaders, the public, and partners through reports and information sessions.
