Political and Cultural Factors in Achieving Continuity

PRIMARY CARE IS A MAJOR FOCUS of health policy discussions in the United States today. In this paper we describe the primary care system established at a small rural Indian Health Service (IHS) hospital, the ZuniRamah Comprehensive Health Care Center, in Zuni, N. Mex. We offer this report as a feasibility study to encourage further evaluation and implementation of primary care in the IHS. The IHS is charged with the health care of American Indians. "The IHS goal is to elevate the health status of Indians and Alaska Natives to the highest level possible. The mission is to ensure . . . [the] availability and accessibility of a comprehensive high quality health care delivery system providing maximum involvement of American Indians and Alaska Natives ." (1). The care can be given in a rural clinic or a major city hospital, in an IHS facility or in a private facility paid for by the IHS. We worked with primary care services at a rural hospital and clinic. Before we describe the Zuni pri-