Native News
Cancer Care Delays in Indian Country Examined in New Policy Report
The University of Oklahoma’s Native Nations Center for Tribal Policy Research has released a new Sovereign Report examining how the federal health care system supports—or sometimes delays—cancer care for Native patients. The report, titled “Purchased/Referred Care and Cancer: Overview and Options for Tribal Consideration,” explores how the Indian Health Service Purchased/Referred Care (PRC) program affects access to cancer screening, diagnosis, treatment and follow-up for eligible tribal citizens.
Authored by Grace Fox (Seminole), a tribal health care policy analyst at the center, the report explains how PRC functions when care must be provided outside of IHS or tribal health facilities. PRC is the mechanism through which IHS authorizes and pays for care delivered by non-IHS providers when services are not available locally. The report outlines the program’s structure and requirements, including eligibility rules, referral timelines, medical priority levels, coordination with other health coverage and the impact of limited funding.
“Our work at the Native Nations Center is first and foremost for tribal leaders and their communities,” Fox said. “This report is designed to provide clear, accessible information about how the Indian Health Service’s Purchased/Referred Care program works in practice and where, particularly in cancer care, delays or gaps are most likely to occur.”
The report highlights cancer as a growing public health concern across Indian Country. American Indian and Alaska Native communities often experience lower cancer screening rates, later-stage diagnoses and higher mortality compared with the overall U.S. population. Because many tribal health systems lack specialized oncology services, patients frequently depend on the PRC program to access cancer care from outside providers.
“When someone is facing a cancer diagnosis, timing matters,” Fox said. “The Purchased/Referred Care program often serves as the bridge to specialty oncology services that aren’t available locally. Understanding that process – from referral to authorization to payment – can make a meaningful difference for patients and for tribal health systems.”
Although the report uses national data and federal policy analysis, it also provides context specific to Oklahoma. The state is home to more than 39 Tribal Nations, including 38 federally recognized tribes, and all 77 counties are designated Purchased/Referred Care delivery areas under federal guidelines. Even with statewide designation, patients must still meet PRC eligibility standards and documentation requirements, and funding availability can influence whether services are approved.
Fox said the report also outlines policy options tribes may consider as they work to improve access to cancer care under the current system. These include utilizing self-determination and self-governance authorities, developing regional partnerships and expanding service-delivery approaches such as mobile cancer screenings and teleoncology—telemedicine-based cancer care that connects patients with specialists remotely. The report also discusses strategies for strengthening care coordination and patient navigation, as well as opportunities for tribes to engage federal policymakers about improving PRC policies.
Fox’s position at the Native Nations Center was created through a collaboration with the Stephenson Cancer Center’s Native American Center for Cancer Health Equity. The role is supported by the Improving Cancer Outcomes in Native American Communities (ICON) grant, a project designed to advance health research and policy focused on reducing cancer disparities among tribal populations. Development of the report involved collaboration among researchers, clinicians and community partners working on cancer health equity issues.
Fox said the report has already drawn interest beyond tribal leadership, including from health care providers, researchers and policymakers both in Oklahoma and nationally. She also noted that the ICON grant—supported in Congress by Tom Cole—has helped open discussions in Washington about how PRC policies affect access to cancer care in tribal communities.
While the report focuses on research and policy analysis to help inform tribal decision-making, Fox said her work is also shaped by personal experience.
“I think of my mom, who had cancer this time last year,” Fox said. “Seeing her lived experience and her struggles, and knowing that time was of the essence, she didn’t have time to go through Indian Health Service because of how long it would have taken.
“That, on its own, shines a light upon the challenges that exist,” Fox said. “It shows why tribes and tribal citizens could benefit from having more information and improved pathways to care.”
Fox emphasized that the report is intended as a resource, not a directive. “We are not telling tribes what to do. We are providing research-driven analysis and options for consideration that tribes can evaluate within their own governance structures and priorities.”