Social Mobility Restrictions on and off American Indian Reservations: Effects on Health Care Access and Utilization During COVID-19

Abstract

We estimate healthcare utilization changes in response to non-pharmaceutical interventions by using cell phone traffic data and a new dataset on social mobility restrictions on and off Native American reservations. Our findings suggest that reservation residents experienced a smaller reduction in visits to healthcare facilities compared to off-reservation residents. This can be attributed to the lack of alternative healthcare options and more acute health conditions prevalent among American Indian populations. Interestingly, we observed a stronger reaction from reservation residents to casino closures than to stay-at-home orders issued by their respective counties, highlighting the importance of considering reservation-specific policies in public health policy analysis. Our study sheds light on critical health issues faced by a vulnerable population that is often overlooked due to the lack of appropriate data. By using an alternative data source that accurately represents reservations, we contribute towards tackling the problem of undercoverage of this population in traditional surveys.

Note:
Funding Information: The authors state that this paper received funds from an NIH grant. No other outside funding was received.

Conflict of Interests: No competing interests to declare.

Keywords: COVID-19, American Indians, Non-Pharmaceutical Interventions, Behavioral Responses