Research Alert: September 4, 2025

Reasons for Experiencing Delayed or Forgone Health Care Among Rural American Indian/Alaska Native and Rural Non-Hispanic White Individuals, 2022

Rural residents and American Indian/Alaska Native (AI/AN) people both experience challenges in health care access. The Indian Health Service (IHS), a federally operated health system intended to fulfill the trust responsibility of the United States to Native nations, is a source of health care for approximately 2.8 million AI/ AN people; just under 30% of the 9.7 million AI/AN people alive today. The purpose of this policy brief is to show reported reasons for experiencing delayed or forgone health care and how this differs between rural AI/AN and rural non-Hispanic white people as well as by IHS care access among rural AI/AN people.

Key Findings:

• Almost one-fifth of rural AI/AN people without access to IHS care report experiencing delayed or forgone health care, a significantly higher percentage than rural AI/ AN people with access to IHS care and rural white non-Hispanic people (18.0% vs 11.4% and 11.4%).
• Rural AI/AN people both with and without access to IHS care are more likely than rural non-Hispanic white people to cite issues with reliable transportation as reasons for experiencing delayed or forgone health care (13.2% and 10.9% vs 4.6%).
• Rural AI/AN people with access to IHS care are most likely to cite issues with health care appointment availability as reasons for experiencing delayed or forgone health care (15.4%), followed by rural AI/AN people without access to IHS care (11.4%) and rural non-Hispanic white people (7.9%).
• Rural AI/AN people with access to IHS care are more likely than rural non-Hispanic white people to cite issues with competing time commitments (15.2% vs 8.1%) as reasons for experiencing delayed or forgone health care.

Additional Resources of Interest:

• More FORHP-funded research on Healthcare access
• More information about the University of Minnesota Rural Health Research Center
• More information from the Rural Health Information Hub's topic guide: Healthcare Access