美国国家公共电台 NPR Native Americans Feel Invisible In U.S. Health Care System（在线收听）

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The life expectancy of Native Americans in some states is 20 years shorter than the national average - 20 years. There may be many factors in this and here's one. About a quarter of Native Americans report experiencing discrimination when they go to a doctor or a health clinic. That's a finding of a poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. Here's Eric Whitney of Montana Public Radio.

ERIC WHITNEY, BYLINE: Margaret Moss knows the Indian Health Service or IHS well. She's a member of the Hidatsa tribe and she's both received IHS care and worked as an IHS nurse. She now teaches at the University of Buffalo. Moss says people who get health care from IHS know two things.

MARGARET MOSS: You'd better get sick by June because there won't be any more money or it's life and limb only. Those are the things that would be authorized.

WHITNEY: The federal government promised to provide American Indians health care when they signed treaties giving up nearly all of their land. But in reality, Congress sets the Indian Health Service budget, and it comes out to about $1,300 per person. That's compared to nearly $7,000 per person for health care in the federal prison system. The result is that there are few IHS hospitals and clinics. And they're pretty limited in what they can do, says Moss.

MOSS: That is the idea out there in Indian country is that I'm not even going to try because it's not going to happen.

WHITNEY: IHS refers a lot of patients out into the private sector for care that it can't provide. But it only has money to pay for about half of them. Moss says that means that a lot of Native Americans just learn to live with health conditions that most Americans get treated.

MOSS: They say they're fine, but they're not. And I call that tolerated illness.

WHITNEY: Even when Native Americans have good private insurance, many say discrimination can keep them from seeing doctors or getting the care they need. Anna Whiting Sorrell is a member of and works for the Confederated Salish and Kootenai Tribes in Montana. She has good insurance through her job. But when she needed a hernia operation a few years ago, she kept falling through the cracks.

ANNA WHITING SORRELL: I got referrals to a gastroenterologist. Somehow that got lost. I never got where I needed to go. The tests got done. The tests are getting lost.

WHITNEY: Sorrell was finally able to get surgery but only after complications from her hernia landed her in the emergency room fairly recently. Private insurance paid for most of the operation and the IHS contributed to the rest. But when it was time to schedule follow-up appointments after her surgery, Sorrell thinks using IHS marked her as an undesirable patient.

WHITING SORRELL: It got denied. My follow-up got denied.

WHITNEY: Sorrell says nobody from IHS or the hospital called to let her know. She felt like she was falling through the cracks again and says at this point in her life, it hit particularly hard.

WHITING SORRELL: I was 57 years old. My mom died at 57.

WHITNEY: Sorrell eventually got her follow-up appointments and is finally starting to feel healed. She's resolved to take good care of herself in what feels like bonus years she's been given. For NPR News, I'm Eric Whitney in Missoula, Mont.