ExpectMore.gov lists four rated areas of IHS: federally administered activities (moderately effective), healthcare-facilities construction (effective), resource- and patient-management systems (effective), and sanitation-facilities construction (moderately effective). All federally recognized Native American and Alaska Natives are entitled to health care. This health care is provided by the Indian Health Service, either through IHS-run hospitals and clinics or tribal contracts to provide healthcare services.[4]
IHS-run hospitals and clinics serve any registered Indian/Alaska Native, regardless of tribe or income. Tribal-contract health care facilities serve only their tribal members, with other qualified Indians/Alaska Natives being offered care on a space-available basis. This policy makes it difficult for an Indian who leaves their tribal home for education or employment to receive health care services to which they are legally entitled. An IHS fact sheet clarifies that Indians are also eligible to apply for low-income health care coverage provided by state and local governments, such as Medicaid. IHS 2007 third-party collections were $767 million, and estimated to be $780 million in 2008.[5]
Some of those who are served by the system are not satisfied with the efficiency of IHS. A contributor to Indianz.com, a website for Native American news, feels that Native Americans are "suffering" at the hands of IHS.[6] She feels IHS is underfunded, and necessary services are unavailable. Others have concerns that the restrictions of the Indian-preference policy do not allow for the hiring of the most highly qualified health professionals and administration staff, so quality of care and efficiency of administration suffer.[citation needed]
IHS also hires Native/non-Native American interns, who are referred to as "externs"; one position available every summer at area offices is the Engineering Externship. Participants are paid according to the GS pay-grade system, which is beneficial for college students. Their GS level is determined according to credit-hours acquired from an accredited college. Engineering Extern participants generally practice field work as needed and office work.