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United States Government Accountability Office:
Serving the Congress and the Nation:
GAO's Strategic Plan:
2007–2012:
GAO-07-1SP:
Serving The Congress And The Nation Gao's Strategic Plan Framework
Mission:
GAO exists to support the Congress in meeting its constitutional
responsibilities and to help improve the performance and ensure the
accountability of the federal government for the benefit of the
American people.
Themes:
* Changing Security Threats;
* Sustainability Concerns;
* Economic Growth & Competitiveness;
* Global Interdependency;
* Societal Change;
* Quality of Life;
* Science & Technology.
Goals and Objectives:
Provide Timely, Quality Service to the Congress and the Federal
Government to Address Current and Emerging Challenges to the Well-being
and Financial Security of the American People related to:
* Health care needs;
* Lifelong learning;
* Work benefits and protection;
* Financial security;
* Effective system of justice;
* Viable communities;
* Natural resources use and environmental protection;
* Physical infrastructure.
Respond to Changing Security Threats and the Challenges of Global
Interdependence involving:
* Homeland security;
* Military capabilities and readiness;
* Advancement of U.S. interests;
* Global market forces.
Help Transform the Federal Government's Role and How It Does Business
to Meet Twenty-first Century Challenges by assessing:
* Roles in achieving federal objectives;
* Government transformation;
* Key management challenges and program risks;
* Fiscal position and financing of the government.
Maximize the Value of GAO by Being a Model Federal Agency and a World-
Class Professional Services Organization in the areas of:
* Client and customer satisfaction;
* Strategic leadership;
* Institutional knowledge and experience;
* Process improvement
* Employer of choice.
Core Values:
* Accountability;
* Integrity;
* Reliability.
[End of section]
Table of Contents:
Abbreviations:
Letter from the Comptroller General:
Our Mission, Goals, Strategies, and Means:
Mission Statement:
Statutory Responsibilities:
Our Strategic Goals:
Key Performance Measures:
Strategies and Means:
Internal Management Challenges:
External Factors That Could Affect Our Performance:
Our Organizational Structure:
Themes Affecting the Plan: Preparing the United States for an
Interdependent World:
Goal 1: Provide Timely, Quality Service to the Congress and the Federal
Government to Address Current and Emerging Challenges to the Well-being
and Financial Security of the American People:
Strategic Objective 1.1: The Health Needs of an Aging and Diverse
Population:
Performance Goal 1.1.1: Evaluate Medicare Reform, Financing, and
Operations:
Performance Goal 1.1.2: Assess Trends and Issues in Private Health
Insurance Coverage:
Performance Goal 1.1.3: Assess Actions and Options for Improving VA’s
and DOD’s Health Care Services:
Performance Goal 1.1.4: Evaluate the Effectiveness of Federal Programs
to Promote and Protect the Public Health:
Performance Goal 1.1.5: Evaluate the Effectiveness of Federal Programs
to Prevent, Prepare for, and Respond to Public Health Emergencies:
Performance Goal 1.1.6: Evaluate Federal and State Program Strategies
for Financing and Overseeing Long-term Health Care:
Performance Goal 1.1.7: Assess State Experiences and Federal Oversight
in Providing Health Insurance Coverage for Low-Income Populations:
Strategic Objective 1.2: Lifelong Learning to Enhance U.S.
Competitiveness:
Performance Goal 1.2.1: Identify Opportunities to Improve Programs That
Target Federal Resources to Activities That Support Lifelong Learning:
Performance Goal 1.2.2: Assess the Effectiveness of Education and
Training Programs in Meeting the Needs of the 21st Century Workforce:
Performance Goal 1.2.3: Support Improved Oversight and Management of
Education and Training Programs:
Strategic Objective 1.3: Benefits and Protections for Workers,
Families, and Children:
Performance Goal 1.3.1: Identify Opportunities to Improve Programs That
Provide Social Services, Economic, and Nutrition Assistance to
Individuals, Families, and Children:
Performance Goal 1.3.2: Identify Ways to Improve Federal Policies and
Support for People with Disabilities:
Performance Goal 1.3.3: Assess the Effectiveness of Strategies and
Safeguards to Protect Workers, as Well as Individuals’ Identities, in
an Increasingly Complex Work and Economic Environment:
Strategic Objective 1.4: Financial Security for an Aging Population:
Performance Goal 1.4.1: Assess the Policy and Administrative Challenges
to the Federal Government in Providing for Americans’ Financial
Security in Retirement:
Performance Goal 1.4.2: Assess the Financial and Administrative
Challenges to Providing Employer-Sponsored Pensions and Retaining Older
Americans in the Workforce, and the Implications of These Challenges
for National Retirement Security:
Performance Goal 1.4.3: Assess Options and Strategies to Help
Individuals Ensure Retirement Security for Themselves and Their
Families:
Strategic Objective 1.5: Ensuring a Responsive, Fair, and Effective
System of Justice:
Performance Goal 1.5.1: Assess the Federal Justice System’s Ability to
Operate Fairly and Efficiently:
Performance Goal 1.5.2: Identify Ways to Improve Federal Agencies’
Ability to Prevent and Respond to Terrorism and Other Major Crimes:
Strategic Objective 1.6: The Promotion of Viable Communities:
Performance Goal 1.6.1: Assess Federal Community and Economic
Development Assistance and Its Impact on Communities:
Performance Goal 1.6.2: Assess the Effectiveness of Federal Initiatives
to Assist Small and Minority-Owned Businesses:
Performance Goal 1.6.3: Assess How the Federal Government Can Balance
Promoting Home Ownership and Financial Risk While Adapting to Changing
Markets and Policies:
Performance Goal 1.6.4: Assess How Well Federal Programs That Support
Affordable Rental Housing Meet Objectives, Manage Financial Risk, and
Improve Recipients’ Well-being:
Strategic Objective 1.7: Responsible Stewardship of Natural Resources
and the Environment:
Performance Goal 1.7.1 Assess the Nation’s Ability to Ensure Reliable
and Environmentally Sound Energy for Current and Future Generations:
Performance Goal 1.7.2: Assess Federal Strategies for Managing Land and
Water Resources in a Sustainable Fashion for Multiple Uses:
Performance Goal 1.7.3: Assess Environmental Protection Strategies and
Programs:
Performance Goal 1.7.4: Assess Efforts to Reduce the Threats Posed by
Hazardous and Nuclear Wastes:
Performance Goal 1.7.5: Assess Federal Programs’ Ability to Ensure a
Plentiful and Safe Food Supply, Provide Economic Security for Farmers,
and Minimize Agricultural Environmental Damage:
Strategic Objective 1.8: A Safe, Secure, and Effective National Physical
Infrastructure:
Performance Goal 1.8.1: Assess Strategies for Identifying, Evaluating,
Prioritizing, Financing, and Implementing Integrated Solutions to
the Nation’s Transportation Infrastructure Challenges:
Performance Goal 1.8.2: Assess the Impact of Transportation and
Telecommunications Policies and Practices on Competition and
Consumers:
Performance Goal 1.8.3: Assess the Federal Government’s Role in
Fostering and Overseeing Telecommunications in the Public Interest:
Performance Goal 1.8.4: Assess Efforts to Improve Safety in Moving
People and Goods across the Nation’s Transportation System:
Performance Goal 1.8.5: Assess the U.S. Postal Service’s Transformation
Efforts to Ensure Its Viability and Accomplish Its Mission:
Performance Goal 1.8.6: Assess Federal Efforts to Plan for, Acquire,
Manage, Maintain, Secure, and Dispose of the Government’s Real Property
Assets:
Goal 2: Provide Timely, Quality Service to the Congress and the Federal
Government to Respond to Changing Security Threats and the Challenges of
Global Interdependence:
Strategic Objective 2.1: Protect and Secure the Homeland from Threats
and Disasters:
Performance Goal 2.1.1: Assess Federal Homeland Security Management,
Resources, and Coordination:
Performance Goal 2.1.2: Assess Efforts to Strengthen Border Security and
Immigration Enforcement to Enhance Homeland Security:
Performance Goal 2.1.3: Assess U.S. National Emergency Preparedness and
Response Capabilities:
Performance Goal 2.1.4: Assess Efforts to Strengthen Security in All
Transportation Modes:
Performance Goal 2.1.5: Evaluate Ways to Strengthen Government
Information Security and Protect Computer and Telecommunications
Systems That Support the Nation’s Critical Infrastructures:
Performance Goal 2.1.6: Assess Homeland Security Information and
Intelligence Sharing:
Strategic Objective 2.2: Ensure Military Capabilities and Readiness:
Performance Goal 2.2.1: Assess DOD’s Ability to Maintain Adequate
Readiness Levels While Transforming Forces and Capabilities to Meet
21st Century Challenges:
Performance Goal 2.2.2: Assess DOD’s Efforts to Respond to Emerging
Threats and Irregular Warfare:
Performance Goal 2.2.3: Assess Progress and Challenges DOD Faces in
Emphasizing Increased Joint Capabilities:
Performance Goal 2.2.4: Assess Overall Human Capital Management to
Ensure a High-Quality Total Force:
Performance Goal 2.2.5: Assess the Ability of Weapon System Acquisition
Programs and Processes to Achieve Desired Outcomes:
Performance Goal 2.2.6: Assess Progress in Improving the Economy,
Efficiency, and Effectiveness of DOD’s Support Infrastructure and
Business Systems and Processes:
Performance Goal 2.2.7: Assess the National Nuclear Security
Administration’s Efforts to Maintain a Safe and Reliable Nuclear
Weapons Stockpile:
Performance Goal 2.2.8: Analyze and Support DOD’s Efforts to Improve
Planning, Programming, Budgeting, Execution, and Program Performance:
Strategic Objective 2.3: Advance and Protect U.S. International
Interests:
Performance Goal 2.3.1: Analyze the Plans, Strategies, Roles, Costs,
and Results of the United States and Its Allies in Conflict
Interventions:
Performance Goal 2.3.2: Analyze the Effectiveness and Management of
U.S. Foreign Aid and Developmental and Humanitarian Programs and
the Tools Used to Implement Them:
Performance Goal 2.3.3: Analyze the Plans, Costs, and Outcomes of
Responding to Challenges to U.S. Strategic Interests:
Performance Goal 2.3.4: Evaluate the Extent to Which U.S. Interests Are
Effectively Served by U.S. Participation in Multilateral
Organizations:
Performance Goal 2.3.5: Assess the Strategies and Management Practices
for U.S. Foreign Affairs Functions and Activities:
Performance Goal 2.3.6: Evaluate the Effectiveness and Coordination of
U.S. International Counterterrorism Efforts:
Performance Goal 2.3.7: Assess the Effectiveness of U.S. and
International Efforts to Prevent Proliferating Nuclear, Biological,
Chemical, and Conventional Weapons and Sensitive Technologies:
Strategic Objective 2.4: Respond to the Impact of Global Market Forces
on U.S. Economic and Security Interests:
Performance Goal 2.4.1: Analyze How U.S. Interests Are Served through
Trade Agreements, U.S. Programs, and International Cooperative
Efforts:
Performance Goal 2.4.2: Improve Understanding of the Effects of a Global
Supplier Base on U.S. National Security Interests:
Performance Goal 2.4.3: Assess How the United States Can Influence
Improvements in the World Financial System:
Performance Goal 2.4.4: Assess the Ability of the Financial Services
Industry and Its Regulators to Maintain a Stable and Efficient
Financial System in the Face of Market Change and Innovation:
Performance Goal 2.4.5: Assess the Effectiveness of Regulatory Programs
and Policies in Ensuring Access to Financial Services and Deterring
Fraud and Abuse in Financial Markets:
Goal 3: Help Transform the Government by Supporting a Broad-Based
Reexamination of Federal Programs:
Strategic Objective 3.1: Reexamine the Federal Government’s Role in
Achieving Evolving National Objectives:
Performance Goal 3.1.1: Examine Emerging Challenges and Opportunities to
Position the Federal Government for the 21st Century:
Performance Goal 3.1.2: Examine the Relationships of Governmental and
Nongovernmental Organizations and the Use of Policy Tools in Achieving
National Goals:
Strategic Objective 3.2: Support the Transformation to Results-Oriented,
High-Performing Government:
Performance Goal 3.2.1: Analyze and Support Efforts to Improve the Human
Capital Infrastructure Key to Successfully Transforming the
Government:
Performance Goal 3.2.2: Assess Efforts to Improve Results-Oriented
Management Oversight across the Government:
Performance Goal 3.2.3: Identify Ways to Improve the Collection,
Dissemination, and Quality of Federal Information:
Performance Goal 3.2.4: Identify Ways to Improve Financial Management
Infrastructure Capacity to Provide Useful Information for Managing
Results and Costs Day to Day:
Performance Goal 3.2.5: Assess the Government’s Planning,
Implementation, and Use of IT to Improve Performance and Modernize
Federal Programs and Operations:
Performance Goal 3.2.6: Identify Ways to Improve How Federal Agencies
Acquire Goods and Services:
Strategic Objective 3.3: Support Congressional Oversight of Key
Management Challenges and Program Risks to Improving Federal Operations
and Ensuring Accountability:
Performance Goal 3.3.1: Highlight High-Risk Federal Programs and
Operations and Monitor Progress of Executive Branch Management
Reforms:
Performance Goal 3.3.2: Identify Ways to Strengthen Accountability for
the Federal Government’s Assets and Operations:
Performance Goal 3.3.3: Assess the Management and Results of the Federal
Investment in Science and Technology and the Effectiveness of Efforts
to Protect Intellectual Property:
Strategic Objective 3.4: Analyze the Government’s Fiscal Position and
Strengthen Approaches for Addressing the Current and Projected Fiscal
Gap:
Performance Goal 3.4.1: Analyze the Structure and Information for
Budgetary Choices and Explore Alternatives for Improvement, Including
Implications for the Long-term Fiscal Position:
Performance Goal 3.4.2: Contribute to Congressional Deliberations on
Tax Policy:
Performance Goal 3.4.3: Identify Specific Opportunities to Reduce the
Tax Gap and Improve Federal Tax Administration:
Performance Goal 3.4.4: Assess the Reliability of Financial Information
on the Government’s Fiscal Position and Financing Sources:
Goal 4: Maximize the Value of GAO by Being a Model Federal Agency and a
World-class Professional Services Organization:
Strategic Objective 4.1: Improve Client and Customer Satisfaction and
Stakeholder Relationships:
Performance Goal 4.1.1: Strengthen Communication with Congressional
Clients:
Performance Goal 4.1.2: Measure Our Clients’ Satisfaction with Our Work
and Act on Client Feedback:
Performance Goal 4.1.3: Assess Internal Customer Satisfaction with Our
Services and Processes and Implement and Measure Improvement Efforts:
Performance Goal 4.1.4: Modernize and Transform the Accountability
Profession in the Public and Private Sectors, Both Domestically and
Internationally, to Leverage Our Resources and Better Meet the
Challenges of the 21st Century:
Strategic Objective 4.2: Lead Strategically to Achieve Enhanced
Results:
Performance Goal 4.2.1: Ensure a Seamless Strategic Planning, Workforce
Planning, and Budget Process to Maximize Results and Manage Risks
within Current and Expected Resources:
Performance Goal 4.2.2: Strengthen Our Strategic Human Capital
Management to Achieve Enhanced Results:
Performance Goal 4.2.3: Ensure Exemplary Practices and Systems in Our
Fiscal Operations:
Performance Goal 4.2.4: Further Enhance IT Governance to Achieve
Strategic Results by Applying Emerging Best Practices in IT Processes
and Management:
Strategic Objective 4.3: Leverage Our Institutional Knowledge and
Experience:
Performance Goal 4.3.1: Maximize the Collection, Use, and Retention of
Essential Organizational Knowledge:
Performance Goal 4.3.2: Increase Our Knowledge-Sharing Capability:
Performance Goal 4.3.3: Enhance Knowledge Sharing with Other National
and International Accountability and Professional Organizations:
Strategic Objective 4.4: Enhance Our Business and Management
Processes:
Performance Goal 4.4.1: Streamline the Engagement Process and Improve
Engagement Services:
Performance Goal 4.4.2: Enhance the Quality, Content, and Appearance of
Our Products:
Performance Goal 4.4.3: Improve Our Administrative and Management
Processes and Use Enabling Technology to Improve Crosscutting
Processes:
Strategic Objective 4.5: Become a Professional Services Employer of
Choice:
Performance Goal 4.5.1: Promote an Environment That Is Fair and
Unbiased and That Values Opportunity and Inclusiveness:
Performance Goal 4.5.2: Provide Our Staff with Tools, Technology, and
a World-class Working Environment:
Performance Goal 4.5.3: Provide a Safe and Secure Workplace:
Performance Goal 4.5.4: Enhance Employee Views about GAO:
Performance Goal 4.5.5: Improve the Development and Experiences of
Newly Hired Staff:
Image Sources:
Abbreviations:
DHS: Department of Homeland Security:
DOD: Department of Defense:
Fannie Mae: Federal National Mortgage Association:
FEMA: Federal Emergency Management Agency:
Freddie Mac: Federal Home Loan Mortgage Corporation:
GAO: Government Accountability Office:
GDP: gross domestic product:
Ginnie Mae: Government National Mortgage Association:
GSE: government-sponsored enterprise:
HUD: Department of Housing and Urban Development:
INTOSAI: International Organization of Supreme Audit Institutions:
IRS: Internal Revenue Service:
IT: information technology:
K-12: kindergarten through 12th grade:
NNSA: National Nuclear Security Administration:
SBA: Small Business Administration:
SCHIP: State Children’s Health Insurance Program:
VA: Department of Veterans Affairs:
[End of section]
Letter from the Comptroller General:
March 2007:
In keeping with GAO’s commitment to update its strategic plan at least
once every 3 years—consistent with the Government Performance and
Results Act—this strategic plan describes our proposed goals and
strategies for serving the Congress for fiscal years 2007 through 2012.
As expected, with the Congress and the nation facing such challenges as
the large and growing long-term fiscal imbalance and increased concerns
about meeting the health care needs of American citizens, this plan
includes bodies of work that address anticipated requests for
evaluations of those and other major issues. In addition, our plan
covers anticipated work related to major government transformation
efforts, especially in the areas of homeland security and defense.
Since our last update to the strategic plan, many challenges continue
and others have emerged. For example, the war on terrorism has
continued, as has the nation’s involvement in Iraq and the ensuing
reconstruction effort that is still unfolding. Hurricanes Katrina and
Rita and predictions of an influenza pandemic have raised the nation’s
awareness of nonmilitary threats to homeland security. Historic budget
deficits have added to our country’s national debt. Perhaps more
disturbing is that our nation’s long-range fiscal outlook remains
unsustainable given existing federal commitments and the challenges of
caring for a growing elderly population. Consequently, policymakers
will be increasingly required to judge what the nation can afford, both
now and in the future. In addition, national boundaries are becoming
less relevant to policymakers as they address a range of economic,
security, social, and environmental issues. At the same time, the
composition of our nation’s population is becoming older and more
diverse, resulting in a virtual kaleidoscope of demands for federal
funds and services. Scientific research and technological developments
provide opportunities to improve the lives of U.S. citizens but also
raise profound ethical questions for society. Accompanying these
changes are new expectations about the quality of life for Americans
and the ways of measuring the nation’s position and progress.
Governance structures are evolving in order to contend with these new
forces and an accelerating pace of change. These broad themes—changing
security threats, sustainability concerns, economic growth and
competitiveness, global interdependence, societal change, quality of
life, and science and technology—provide the context for our plan.
The broad goals and objectives of our plan have not altered
dramatically since our last plan, but events such as the continuing war
in Iraq and recent and predicted natural disasters account for some
modifications in emphasis. Also, we have retained our goal of becoming
a model agency and world-class professional services organization—a
goal that remains as vital to us as ever. To ensure that our plan
reflects evolving congressional and national needs, we solicited input
on the plan from members of the Congress and their staffs, our sister
congressional agencies—the Congressional Budget Office and the
Congressional Research Service, the inspectors general, state and local
government audit organizations, and other key accountability
organizations. We are dedicated to our mission of serving the Congress
and our nation and to achieving results that are unmatched by any other
accountability organization in the world. By working together, leading
by example, and focusing on our results, we hope to continue to improve
our performance and strengthen the GAO brand name both domestically and
internationally. If you would like to know more about specific areas of
our work, detailed performance and accountability information is
available on our Web site at [hyperlink, http://www.gao.gov/sp.html].
If you have questions about the strategic plan, please contact me at
(202) 512-5500 or walkerd@gao.gov or Gene L. Dodaro, Chief Operating
Officer, at (202) 512-5600 or dodarog@gao.gov.
Signed by:
David M. Walker:
Comptroller General of the United States:
[Image: Picture of a Bald Eagle]
Source: See Image Sources.
[End of image]
Our Mission, Goals, Strategies, and Means:
[Image: Picture of the U. S. Capitol Building]
Source: See Image Sources.
[End of image]
Mission Statement:
The Government Accountability Office (GAO) exists to support the
Congress in meeting its constitutional responsibilities and to help
improve the performance and ensure the accountability of the federal
government for the benefit of the American people.
Statutory Responsibilities:
Through the Budget and Accounting Act of 1921, the Congress established
GAO with the broad role of investigating “all matters relating to the
receipt, disbursement, and application of public funds” and to “make
recommendations looking to greater economy or efficiency in public
expenditures.” Since World War II, the Congress has clarified and
expanded that original charter in the following ways:
* The Government Corporation Control Act of 1945 provided GAO the
authority to audit the financial transactions of government
corporations.
* The Budget and Accounting Procedures Act of 1950 assigned GAO
responsibility for establishing accounting standards for the federal
government and carrying out audits of internal controls and financial
management.
* The Legislative Reorganization Act of 1970 expressly authorized GAO
to conduct program evaluations and analyses of a broad range of federal
activities.
* The General Accounting Office Act of 1980 reiterated GAO’s authority
to obtain agency and other records needed for its investigations and
evaluations and added the authority for GAO to enforce its access
rights in court.
* The Chief Financial Officers Act of 1990 and the Government
Management Reform Act of 1994 authorized GAO to audit agencies’
financial statements and annually audit the consolidated financial
statements of the United States.
* Numerous other laws complement GAO’s basic audit and evaluation
authorities, including the Congressional Budget and Impoundment Control
Act of 1974, which provided for GAO review of reported or unreported
impoundments; the Inspector General Act of 1978, which provided for GAO-
established standards for the audit of federal programs and activities;
and the Competition in Contracting Act of 1984, which provided for
GAO’s review of protested federal contracting actions.
At GAO, we implement our statutory responsibilities by engaging in a
range of oversight, insight, and foresight activities that span the
full breadth and scope of federal activities and programs. We publish
thousands of reports and other documents annually and provide a number
of other related services. By making recommendations to improve the
practices and operations of government agencies, we contribute not only
to the increased effectiveness of and accountability for federal
spending, but also to the enhancement of the taxpayers’ trust and
confidence in their federal government. We also look at national and
international trends and challenges to anticipate their implications
for public policy.
Our Strategic Goals:
To accomplish our mission, we use a strategic planning and management
framework that is based on a hierarchy of four elements (see fig. 1),
beginning at the highest level with the following four strategic
goals:
* Strategic Goal 1: Provide Timely, Quality Service to the Congress and
the Federal Government to Address Current and Emerging Challenges to
the Well-being and Financial Security of the American People:
* Strategic Goal 2: Provide Timely, Quality Service to the Congress and
the Federal Government to Respond to Changing Security Threats and the
Challenges of Global Interdependence:
* Strategic Goal 3: Help Transform the Government by Supporting a Broad-
Based Reexamination of Federal Programs:
* Strategic Goal 4: Maximize the Value of GAO by Being a Model Federal
Agency and a World-class Professional Services Organization.
Figure 1: Our Strategic Planning Hierarchy:
This figure depicts four stacked blocks, indicating the following, from
bottom to top:
* Key efforts (300+);
* Performance goals (93);
* Strategic objectives (21);
* Strategic goals (4).
[End of figure]
Our work is primarily aligned under the first three strategic goals,
which span issues that are both domestic and international, affect the
lives of all Americans, and influence the extent to which the federal
government serves the nation’s current and future interests. The fourth
goal is our only internal one and is aimed at maximizing our
productivity through such efforts as investing steadily in information
technology (IT) to support our work; ensuring the safety and security
of our people, information, and assets; pursuing human capital
transformation; and leveraging our knowledge and experience.
Each of our strategic goals is further defined by strategic objectives,
performance goals, and key efforts. The strategic objectives and
performance goals provide progressively more detailed descriptions of
what we plan to achieve. Each key effort outlines a body of work that
supports a performance goal. The performance goals and key efforts
described later in this strategic plan cover areas in which we plan to
complete work by the end of fiscal year 2009.
Key Performance Measures:
We primarily use quantitative performance measures to assess progress
in achieving our strategic goals and objectives. Collectively, these
measures help demonstrate the degree to which we (1) provide timely,
quality service to the Congress and the federal government so that they
can respond to current and emerging challenges and (2) help the
government meet 21st century challenges by transforming its role and
its ways of doing business. To assess our progress toward achieving our
strategic goals and their objectives, we use a variety of quantitative
measures, which are described in table 1. We set performance targets
for all of these quantitative measures annually and compare our actual
performance with the targets.
We publish annual performance and accountability reports that describe
our progress in achieving our performance measures. These are available
on our Web site, [hyperlink, http://www.gao.gov/sp.html]. We are
continuing to refine our measures, working toward a balanced set of
measures that evaluate performance based on four key perspectives: our
results, our clients, our people, and our internal operations.
Table 1: Annual Quantitative Performance Measures:
Measure: Financial benefits;
Description: Benefits to the federal government that can be estimated
in dollar terms (e.g., decreased costs, increased revenues, or revenues
made available for other purposes) that result in improved services to
the public, improved statutes or regulations, or improved government
business operations that occurred because of work that we completed
over the past several years.
Measure: Nonfinancial benefits;
Description: Benefits to the federal government that cannot be
estimated in dollar terms that result in improved services to the
public, improved statutes or regulations, or improved government
business operations that occurred because of work that we completed
over the past several years.
Measure: Past recommendations implemented;
Description: Of the recommendations made 4 fiscal years prior to the
current fiscal year, the percentage of recommendations that were
implemented.
Measure: Percentage of products with recommendations;
Description: Of the written products issued in the fiscal year, the
percentage that included at least one recommendation. Not all products
that we issue during the fiscal year contain recommendations—some
provide the Congress with policy options or are purely informational.
Measure: Testimonies;
Description: The number of hearings at which we presented testimony.
Measure: Timeliness;
Description: From a survey sent to our congressional clients for our
more significant written products, the percentage that indicated the
product was delivered on time.
Measure: New hire rate;
Description: The ratio of the number of people hired to the number we
planned to hire.
Measure: Acceptance rate;
Description: The ratio of the number of applicants accepting offers to
the number of offers made.
Measure: Retention rate;
Description: The ratio of the number of people who did not leave GAO
during the fiscal year to the average number of people on board during
the year. (Retention rate is the inverse of attrition rate.) We examine
two calculations of retention rate—one that includes retirees and one
that excludes retirees.
Measure: Staff development;
Description: From an annual employee survey, the percentage of people
responding favorably to questions on internal, external, and on-the-job
training.
Measure: Staff utilization;
Description: From an annual employee survey, the percentage of people
responding favorably to questions on our use of staff’s knowledge and
skills.
Measure: Leadership;
Description: From an annual employee survey, the percentage of people
responding favorably to questions about specific qualities of our
managers, such as whether leaders treated staff fairly, made timely
decisions, demonstrated GAO’s core values, implemented change
effectively, and dealt effectively with diversity issues.
Measure: Organizational climate;
Description: From an annual employee survey, the percentage of people
responding favorably to questions on teamwork, morale, and overall
satisfaction.
Measure: Help get job done;
Description: From an annual employee survey, we calculate a composite
score from questions related to how well internal processes help
employees get their jobs done. The composite score represents how
employees rated their satisfaction with these services relative to how
they rated the importance of those services to them. The importance
scores and satisfaction levels are both rated on a scale of 1 (low) to
5 (high).
Measure: Quality of work life;
Description: From an annual employee survey, we calculate a composite
score from questions related to how internal processes affect
employees’ quality of work life. The composite score represents how
employees rated their satisfaction with these services relative to how
they rated the importance of these services to them. The importance
scores and satisfaction levels are both rated on a scale of 1 (low) to
5 (high).
Source: GAO.
[End of table]
Another major evaluation we used to inform the update of the strategic
objectives under goals 1, 2, and 3 was the January 2007 edition of our
biennial high-risk report. This report provides the status of major
government operations considered high risk because of their greater
vulnerabilities to waste, fraud, abuse, and mismanagement. The series
is, among other things, a valuable planning tool for us, helping us
identify those areas in which our continued efforts are needed to
maintain the focus on important policy and management issues facing the
nation.
Similarly, we drew from our report 21st Century Challenges: Reexamining
the Base of the Federal Government in preparing this strategic plan.
This report was intended to help the Congress in reviewing and
reconsidering the base of federal spending and tax programs. In
preparing our strategic plan, we took into consideration the federal
activities that are discussed in this report and the related work that
we might perform to support congressional decision making.
Finally, our Office of the Inspector General evaluates the
administration of the agency, including an assessment of key
performance measurements. The Inspector General’s evaluations are
useful for ensuring that our operations are efficient and economical
and serve as additional input for updating the objectives under
strategic goal 4. We also evaluated (1) our engagement policies and
quality control practices and (2) the effectiveness of a number of our
core and support processes to enhance their usefulness and improve
efficiency.
Figure 2: GAO's Business Model:
{See PDF for image]
This figure is a series of concentric circles consisting of labeled
arrows pointing to one another. The outer circle of arrows is labeled
as follows:
* Meet Statutory Responsibilities;
* Improve Performance;
* Ensure Accountability.
The first inner circle of arrows is labeled as follows:
* Infrastructure Services;
- Information and Technology Management;
- Human Capital Management;
- Financial Services;
- Facilities Management Safety and Security;
* Oversight, Insight, and Foresight;
- Legal Decisions and Opinions;
- Nonaudit services;
- Audit Services;
* Engagement Services;
- Expert Services;
- Knowledge Management and Communications.
The second inner circle of arrows is labeled as follows:
* Integrity;
* Accountability;
* Reliability.
Inside that circle the following text is displayed:
* Strategic Management:
- Strategic Planning and Policy;
- Relationship Management;
- Portfolio Management.
Source: GAO.
[End of figure]
Strategies and Means:
The business model depicted in figure 2 shows how we strategically
manage our work to meet our statutory requirements while improving our
performance and ensuring that we are accountable to our clients. Our
strategic management processes—including efforts to plan our work,
periodically assess whether we are on the right track, and make
adjustments when necessary—are at the center of this model. Staff
aligned with all four of our strategic goals are involved in these
processes. In addition, our three core values of accountability,
integrity, and reliability are part of the model’s core, which is
appropriate because they are an integral part of all of our work. The
remaining business of the agency is divided into the following three
parts:
* Oversight, insight, and foresight. We conduct performance audits,
financial audits, attestations, and investigations; issue legal
decisions and opinions; and provide nonaudit services for our clients.
This work is aligned primarily with strategic goals 1, 2, and 3.
* Engagement services. Some of our staff provide direct support to our
oversight, insight, and foresight activities by lending expert services
that include legal analyses and counsel, quality assurance, and design
and methodological development. This work also is aligned primarily
with goals 1, 2, and 3.
* Infrastructure services. We conduct foundational services that
support GAO operations and activities—many of which are aligned with
strategic goal 4. These services include financial management, IT
management, security and safety, and human capital management.
Throughout GAO, we emphasize two overarching strategies to achieving
our strategic goals. These are (1) providing information from our work
to the Congress and the public and (2) continuing and strengthening our
internal operations. Specifically, we achieve our results mainly
through the actions taken by the Congress and federal agencies in
response to the information and recommendations that we provide. Our
strategies also emphasize the importance of (1) working with other
organizations on crosscutting issues and (2) effectively addressing
the challenges to achieving our agency’s goals and recognizing the
internal and external factors that could impair our performance.
Through these strategies, which have proven successful for us for a
number of years, we plan to achieve the level of performance that is
needed to meet our annual performance measures as well as our multiyear
performance goals. That level of performance, in turn, will allow us to
achieve our strategic goals.
Attaining our three external strategic goals (goals 1, 2, and 3) and
their related objectives rests, for the most part, on providing
professional, objective, fact-based, nonpartisan, nonideological, fair,
and balanced information to support the Congress in carrying out its
constitutional responsibilities. To implement the performance goals and
key efforts related to these three goals, we develop and present
information in a number of ways, including:
* evaluations of federal programs, policies, operations, and
performance;
* oversight of government operations through financial and other
management audits to determine whether public funds are spent
efficiently, effectively, and in accordance with applicable laws;
* investigations to assess whether illegal or improper activities are
occurring; analyses of the financing for government activities;
* constructive engagements in which we work proactively with agencies,
when appropriate, to help guide their efforts toward achieving positive
results;
* legal decisions and opinions to determine whether agencies are in
compliance with applicable laws and regulations;
* policy analyses to assess needed actions and the implications of
proposed actions; and:
* additional assistance to the Congress in support of its oversight,
appropriations, legislative, and other responsibilities.
We conduct specific engagements based on requests from congressional
committees and mandates written into legislation, resolutions, and
committee reports. We also coordinate our work with our sister agencies
in the legislative branch and the offices of inspector general in the
executive branch. While we devote most of our engagement resources to
work requested or mandated by the Congress, we initiate some work under
the Comptroller General’s authority. Traditionally, this work has been
related to government programs and operations that we have identified
as being at high risk for fraud, abuse, or mismanagement; reviews of
agencies’ budget requests; and various emerging challenges that are of
broad-based interest to the Congress, such as the cost of fighting
terrorism and the status of the reconstruction efforts in Iraq.
[Footnote 1] When appropriate, we make recommendations that are
intended to improve the accountability, operations, and services of
government agencies; contribute to increasing the effectiveness of
federal spending; and enhance the taxpayers’ trust and confidence in
their government.
Our staff are responsible for following high standards for gathering,
documenting, and supporting the information we collect and analyze.
More often than not, this information is documented in a product that
is made available to the public. We generally issue around 1,200 to
1,300 products each year, both electronically and in printed format. In
addition, we publish about 250 to 350 legal decisions and opinions each
year. Our products include the following:
* letter reports, chapter reports, and other written correspondence;
* testimonies and statements for the record, where the former are
delivered orally by one or more of our senior executives at a hearing
and the latter are provided for inclusion in the congressional record;
* oral briefings, which are usually given directly to congressional
staff members; and:
* legal decisions and opinions resolving bid protests and addressing
issues of appropriations law, as well as opinions on the scope and
exercise of authority of federal officers.
We also produce special publications on specific issues of general
interest to all Americans. For example, we issued a primer on motor
fuels to help improve public understanding of the major factors that
influence the U.S. price of gasoline and we issued a guide on Social
Security that answers concisely some basic questions about how the
program works and why it needs to be reformed. [Footnote 2] Our
publication, Principles of Federal Appropriations Law, is viewed both
within and outside of the government as the primary resource in the
area of appropriations law. It discusses in detail Comptroller General
and federal case law on the availability, use, and control of federal
funds. In addition, we maintain the government’s repository of reports
of Antideficiency Act violations and make available on our Web site
various information extracted from those reports. Collectively, our
products always contain information and often conclusions and
recommendations that allow us to achieve our external strategic goals.
Another means of ensuring that we are achieving our goals is to examine
the impact of our past work and use that information to shape our
future work. Consequently, we evaluate actions taken by federal
agencies and the Congress in response to our past work. The results of
these evaluations are reported in terms of the financial benefits and
nonfinancial benefits that reflect the value of our work. We actively
monitor the status of our open recommendations—those that remain valid
but have not yet been implemented—and report our findings annually to
the Congress and the public (see [hyperlink
http://www.gao.gov/openrecs.html]).
Two reports have been especially valuable planning tools because they
help us to identify areas where our continued efforts are needed to
maintain the focus on important policy and management issues that the
nation faces. First, our biennial high-risk report, most recently
updated in January 2007, provides a status report on major government
operations that we consider high risk because they are vulnerable to
waste, fraud, abuse, and mismanagement or are in need of broad-based
transformation. We have made hundreds of recommendations to improve
these high-risk operations and plan to continue work that will lead to
further improvements. Second, we use our report on 21st century
challenges, which was issued in February 2005, to guide a portion of
our planned work. This report highlights current and emerging issues
facing the nation. For example, the report concludes that the nation’s
growing fiscal imbalance stems primarily from the aging of the
population and rising health care costs. Absent significant changes on
the spending, revenue, or both sides of the budget, these long-term
deficits will test the capacity of current and future generations to
afford federal commitments. Addressing the nation’s long-term fiscal
imbalances constitutes a major transformational challenge that may take
a generation to resolve.
To attain our fourth strategic goal—an internal management goal—and its
related objectives, we conduct surveys of our congressional clients and
internal customers to obtain feedback on our products, processes, and
services, and perform studies and evaluations to identify ways in which
to improve them. These studies and evaluations have included:
* assessing our administrative processes and ways to determine internal
customers’ satisfaction;
* surveying employees’ about their work environment;
* surveying employees’ skills and work preferences;
* conducting an ongoing review of our workforce and our future needs
for skilled mission and support staff as well as for senior managers;
* evaluating the practices and procedures that analysts use to develop
core products and whether these practices adhere to policies that
ensure the quality of our engagements and products;
* extensively studying our training and curriculum strategies;
* comprehensively assessing our building security and safety,
especially in the event of a major disaster or national security
incident; and:
* conducting annual security and other related audits of our IT
systems.
Because achieving our strategic goals and objectives also requires
strategies for coordinating with other organizations with similar or
complementary missions, we:
* use advisory panels and other bodies to inform our strategic and
annual work planning and;
* maintain strategic working relationships with other national and
international government accountability and professional organizations,
including the federal inspectors general, state and local audit
organizations, and other national audit offices.
These two types of strategic working relationships allow us to extend
our institutional knowledge and experience; to leverage our resources;
and in turn, to improve our service to the Congress and the American
people.
Through newly established forums and a number of ongoing advisory
boards and panels, we gather information and perspectives for our
strategic and annual performance planning efforts. Ongoing advisory
boards and panels also support strategic and annual work planning by
alerting us to issues, trends, and lessons learned across the national
and international audit communities that should factor into our work.
These groups include the Comptroller General’s Advisory Board, the 40
members of which represent both the public and private sectors and have
broad expertise in areas related to our strategic objectives. The board
meets with our senior managers annually to share its views on our
strategic direction and specific initiatives. Through the National
Intergovernmental Audit Forum, chaired by the Comptroller General, and
10 regional intergovernmental audit forums, we consult regularly with
federal inspectors general and state and local auditors. In addition,
through the Domestic Working Group, the Comptroller General and the
heads of 18 federal, state, and local audit organizations exchange
information and seek opportunities to collaborate.
Internationally, we participate in the International Organization of
Supreme Audit Institutions (INTOSAI), the professional organization of
the national audit offices of 184 countries. The Comptroller General
also leads the Global Working Group, through which the heads of our
counterparts from 15 countries meet annually to discuss mutual
challenges, share experiences, and identify opportunities for
collaboration.
Our Strategic Planning and External Liaison office takes the lead and
provides strategic focus for the work with external partner
organizations, while our research, audit, and evaluation teams lead the
work with most of the issue-specific organizations.
We combine our general strategies with specific strategies for each
strategic objective. These specific strategies take the form of
performance goals, each of which has a set of key efforts that connect
with our day-to-day work. These performance goals and key efforts are
described later in this plan.
Internal Management Challenges:
For at least the next 3 fiscal years, we anticipate continuing to
address three management challenges—physical security, information
security, and human capital—because they are evolving and will require
us to continuously identify ways to adapt and improve. Under strategic
goal 4, we establish performance goals focused on each of our
management challenges, track our progress in completing the key efforts
for those performance goals quarterly, and report each year on our
progress toward meeting the performance goals. (See our performance and
accountability report for a more complete description of these
challenges.)
External Factors That Could Affect Our Performance:
Several external factors could affect the achievement of our
performance goals. These include the amount of resources we receive,
shifts in the content and volume of our work, and various national and
international developments. Limitations imposed on our work by other
organizations or limitations on the ability of other federal agencies
to make the improvements we recommend are additional factors that could
affect the achievement of our goals.
As the Congress focuses on unpredictable events—such as terrorism,
natural disasters, and military conflicts and threats abroad—the mix of
work we are asked to undertake may change, diverting our resources from
some strategic objectives and performance goals. We can and do mitigate
the impact of these events on the achievement of our goals in various
ways. For example in fiscal year 2006, we:
* stayed abreast of current events (such as protecting U.S. ports and
borders and preventing possible pandemics) and communicated frequently
with our congressional clients in order to be alert to possibilities
that could shift the Congress’s priorities or trigger new priorities;
* quickly redirected our resources when appropriate (e.g., on the cost
and recovery efforts related to Hurricane Katrina) so that we could
deal with major changes as they occurred;
* maintained broad-based staff expertise (i.e., in the Social Security,
health care financing, and homeland security areas) so that we could
readily address emerging needs; and:
* initiated research under the Comptroller General’s authority on
several selected topics, including various issues relating to Iraq, the
U.S. federal elections, and our 21st century challenges and high-risk
work.
We have experienced heavy demand from the Congress for work in a number
of subject areas, especially in the disaster recovery and preparedness
areas in the aftermath of Hurricane Katrina and in the health care
area. Our ability to effectively manage this demand could have an
impact on our ability to meet our performance targets. We will continue
to manage these requests in order to minimize any negative impact they
may have on our ability to meet the needs of the Congress and the
American people. Given large current federal budget deficits and the
nation’s long-range fiscal imbalance, the Congress is likely to place
increasing emphasis on fiscal constraint. While it is unclear how we
will ultimately be affected, it is reasonable to assume that any
attempt to exercise additional budgetary discipline in the legislative
branch will include our agency. As a result, while we believe that we
submit reasonable and responsible budget requests and we know that the
return on investment that we generate is unparalleled, we must plan and
prepare for the possibility of significant and recurring constraints on
the resources made available to the agency. In addition, because almost
80 percent of our budget is composed of people-related costs, any
serious budget situation will likely have an impact on our human
capital policies and practices. This, in turn, would have an impact on
our ability to serve the Congress and meet our performance targets.
While the nature and extent of any such budget constraints cannot be
determined at the present time, our executive team is engaged in a
range of related planning activities. It is both appropriate and
prudent for us to engage in such planning. At the same time, we are
hopeful that the Congress will recognize that performance-based
budgeting concepts would support providing additional resources to
entities with prudent budget requests and proven performance results.
If the Congress employs such an approach, we should be in a good
position to continue to provide a high rate of return on the resources
invested in the agency.
A growing area for us involves our work on bid protests. As required by
law, our General Counsel prepares Comptroller General procurement law
decisions that resolve protests filed by disappointed bidders. These
bidders challenge the way individual federal procurements are being
conducted or how the contracts were awarded. In recent years, we have
experienced an increase in the number of bid protests that have been
filed, and in fiscal year 2005 the Congress enacted legislation that
expanded our authority to allow certain representatives of affected
government employees to protest when the private sector wins a private-
public competition. We will continue to monitor our workload in this
area to ensure that we meet our statutory responsibilities with minimal
negative impact on our other work.
Another external factor is the extent to which we can obtain access to
certain types of information. With concerns about operational security
being unusually high at home and abroad, we may have more difficulty
obtaining information and reporting on sensitive issues. Historically,
our auditing and information gathering have been limited whenever the
intelligence community is involved. In addition, we do not have a right
of access to records or other materials held by other countries or,
generally, by the multinational institutions that the United States
works with to protect its interests. Consequently, our ability to fully
assess the progress being made in addressing several national and
homeland security issues may be hampered. Given the heightened security
environment, we also anticipate that more of our reports may be subject
to classification reviews than in the past, which means that the public
dissemination of these products may be limited. We plan to work with
the Congress to identify both legislative and nonlegislative
opportunities for strengthening our access authority as necessary and
appropriate.
Our Organizational Structure:
As the Comptroller General of the United States, David M. Walker is the
head of GAO and is serving a 15-year term that began in November 1998.
Three other executives join Comptroller General Walker to form GAO’s
Executive Committee; these executives are Chief Operating Officer Gene
L. Dodaro, Chief Administrative Officer/Chief Financial Officer
Sallyanne Harper, and General Counsel Gary Kepplinger.
To achieve our strategic goals, our staff is organized as shown in
figure 3. For the most part, our 13 research, audit, and evaluation
teams perform the work that supports strategic goals 1, 2, and 3—our
three external strategic goals—with several of the teams working in
support of more than one strategic goal. Senior executives in charge of
the teams manage a mix of engagements to ensure that we meet the
Congress’s need for information on quickly emerging issues as we also
continue longer-term work efforts that flow from our strategic plan. To
serve the Congress effectively with a finite set of resources, senior
managers consult with our congressional clients and determine the
timing and priority of engagements for which they are responsible. In
fiscal year 2005, we formed a new unit—Forensic Audits and Special
Investigations—within our Financial Management and Assurance team. This
unit was designed to provide the Congress with high-quality forensic
audits; investigations of fraud, waste, and abuse; and evaluations of
security vulnerabilities and other appropriate investigative services
as part of its own assignments or in support of other teams. This unit
follows up on engagements and referrals from our other teams when its
special services are required to help determine whether legislative or
administrative actions are necessary. The unit is composed of
investigators and staff from our former Office of Special
Investigations; auditors from the Financial Management and Assurance
team who have experience with forensic audits; and staff in General
Counsel who worked with FraudNet—our online system designed to
facilitate the reporting of allegations of fraud, waste, abuse, or
mismanagement of federal funds.
As described below, General Counsel supports the work of all of our
teams. In addition, the Applied Research and Methods team assists the
other teams on matters requiring expertise in areas such as economics,
research design, and statistical analysis. And staff in many offices,
such as Strategic Planning and External Liaison, Congressional
Relations, Opportunity and Inclusiveness, Quality and Continuous
Improvement, Public Affairs, and the Chief Administrative Office,
support the efforts of the teams. This collaborative process, which we
refer to as matrixing, increases our effectiveness, flexibility, and
efficiency in using our expertise and resources to meet congressional
needs on complex issues.
Figure 3: Our Organizational Structure:
This figure is an organizational chart. At the top is the Controller
General of the United States, with horizontal connections to the
following:
* Public Affairs;
* Strategic Planning and External Liaison;
* Congressional Relations;
* Opportunity and Inclusiveness; and;
* Inspector General.
The next level on the chart includes three positions:
* General Counsel;
* Chief Operating Officer;
* Chief Administrative Officer/Chief Financial Officer.
Connected to the General Counsel are Goals 1, 2, 3 and 4, with the
following information:
* Provide audit and other legal support services for all goals and
staff offices;
* Manage GAO's bid protest and appropriations law work.
The Chief Operating Officer connects to Teams/Field Operations and to
Quality and Continuous Improvement. The Team/Field Operations connect
to Goals 1, 2, and 3, with the following information:
Goals 1: Provide timely, quality service to the Congress and the
federal government to address current and emerging challenges to the
well-being and financial security of the American people:
* Education, Workforce, and Income Security;
* Financial Markets and Community Investment;
* Health Care;
* Homeland Security and Justice;
* Natural Resources and Environment;
* Physical Infrastructure.
Goal 2: Provide timely, quality service to the Congress and the federal
government to respond to changing security threats and the challenges
of global interdependence:
* Acquisition and Sourcing Management;
* Defense Capabilities and Management;
* International Affairs and Trade.
Goals 3: Help transform the federal government’s role and how it does
business to meet 21st century challenges:
* Applied Research and Methods;
* Financial Management and Assurance;
– Forensic Audits and Special Investigations;
* Information Technology;
* Strategic Issues.
The Chief Administrative Officer/Chief Financial Officer connects to
Goal 4, with the following information provided:
Goal 4: Maximize the value of GAO by being a model federal agency and a
world-class professional services organization:
* Controller;
* Human Capital Office;
– Chief Human Capital Officer;
* Information Systems and Technology Services;
– Chief Information Officer;
* Knowledge Services;
– Chief Knowledge Services Officer;
* Professional Development Program.
Source: GAO.
Note: General Counsel’s structure largely mirrors the agency’s goal
structure, and attorneys who are assigned to goals work with the teams
on specific engagements. Thus, the dotted lines in this figure indicate
General Counsel’s support of or advisory relationship with the goals
and teams rather than a direct reporting relationship.
[End of figure]
General Counsel is structured organizationally along subject matter
lines to facilitate the delivery of legal services. This structure
allows General Counsel to (1) provide legal support to GAO and its
audit teams concerning all matters related to their work and (2)
produce legal decisions and opinions for the Comptroller General.
Specifically, the goal 1, goal 2, and goal 3 groups in General Counsel
are organized to provide each of the audit teams with a corresponding
team of attorneys dedicated to supporting each team’s needs for legal
services. In addition, these groups prepare advisory opinions to
committees and members of the Congress on agency adherence to laws
applicable to their programs and activities. General Counsel’s Legal
Services group provides in-house support to GAO’s management on a wide
array of human capital matters and initiatives and on information
management and acquisition matters and defends the agency in
administrative and judicial forums. Finally, attorneys in the
Procurement Law and the Budget and Appropriations Law groups prepare
administrative decisions and opinions adjudicating protests to the
award of government contracts or opining on the availability and use of
appropriated funds.
For strategic goal 4—our fourth and only internal strategic goal— staff
in our Chief Administrative Office take the lead. They are assisted on
specific key efforts by the Applied Research and Methods team and by
staff offices such as Strategic Planning and External Liaison,
Congressional Relations, Opportunity and Inclusiveness, Quality and
Continuous Improvement, and Public Affairs. In addition, attorneys in
General Counsel, primarily in the Legal Services group, provide legal
support for goal 4 efforts. To maximize their productivity, we must
make steady investments in IT. We must also ensure the safety and
security of our people, information, and assets. The strategies we will
use to ensure that we have the human capital we need to carry out our
responsibilities and that our human capital, business processes, IT,
and other resources are well managed and secure are covered under the
fourth strategic goal of this plan.
Throughout GAO, we maintain a workforce of highly trained professionals
with degrees in many academic disciplines, including accounting, law,
engineering, public and business administration, economics, and the
social and physical sciences. About three-quarters of our approximately
3,200 employees are based at our headquarters in Washington, D.C; the
rest are deployed in 11 field offices across the country. (See fig. 4.)
Staff in these field offices are aligned with our research, audit, and
evaluation teams and perform work in tandem with our headquarters staff
in support of our external strategic goals. Through our field office
structure, we have been able to attract and retain top talent from
across the country.
Figure 4: Our Office Locations:
This figure is a map of the Continental United States, depicting GAO
Office locations:
* Boston, MA;
* Washington, DC;
* Norfolk, VA;
* Dayton, OH;
* Chicago, IL;
* Atlanta, GA;
* Huntsville, AL;
* Dallas, TX;
* Denver, CO;
* Los Angeles, CA;
* San Francisco, CA;
* Seattle, WA.
Source: See Image Sources.
[End of figure]
Themes Affecting the Plan: Preparing the United States for an
Interdependent World:
In charting our work over the next several years, our strategic plan
takes into account the forces that are likely to shape our society, the
place of the United States in the world, and the role of the federal
government. We have grouped these forces under seven themes that
suggest major trends that may influence congressional actions and that
form a context for our strategic goals and objectives. Table 2
summarizes the themes, and a detailed description of each theme is
provided in a separate publication titled Forces That Will Shape
America’s Future: The Themes from GAO’s Strategic Plan (GAO-07-467SP),
which was issued in conjunction with this update of the strategic
plan.
Our nation faces a range of key public policy trends, challenges, and
opportunities that transcend geopolitical and sectoral boundaries.
Through our strategic planning efforts, we have identified seven key
themes that embrace the major trends that are likely to shape our
society, the place of the United States in the world, and the role of
the federal government in the decades to come. These themes are
ensuring the security and safety of the nation; sustaining our nation’s
capacity, national resources, and environment, especially given the
nation’s large and growing long-term fiscal imbalance; maintaining
economic growth and competition; recognizing global interdependence
related to people, information, goods, and capital; adapting to
societal changes resulting from demographic and other shifts;
sustaining U.S.citizens’ quality of life; and managing advancements in
science and technology.
These seven themes and the issues they encompass will require the
federal government to form strategic partnerships and alliances with
state and local governments, as well as with the governments of other
nations around the world. They will also require partnering for
progress between levels of government, the private sector, and the
independent sector. Successful approaches to these issues will also
need to focus on maximizing value, managing risks, and achieving real
and sustainable results.
Any significant changes in these areas over the period covered by this
plan will affect our ability to meet our goals and objectives. We will
therefore continue to track developments in these areas to ensure that
our plan continues to respond to the needs of the Congress, the federal
government, and the American people.
Table 2: Forces Shaping the United States and Its Place in the World:
* Changing security threats:
The world has changed dramatically in overall security, from the
conventional threats posed during the Cold War era to more
unconventional and asymmetric threats. Providing for people’s safety
and security requires attention to threats as diverse as terrorism,
violent crime, natural disasters, and infectious diseases. The response
to many of these threats depends not only on the action of the U.S.
government but also on the cooperation of other nations and
multilateral organizations, as well as on state and local governments
and the private and independent sectors. Complicating such efforts are
a number of failed states allowing the trade of arms, drugs, or other
illegal goods; the spread of infectious diseases; and the accommodation
of terrorist groups. Meeting the nation’s defense needs in the future
may prompt decision makers to reexamine fundamental aspects of the
nation’s security programs, such as how the Department of Defense (DOD)
and the Department of Homeland Security (DHS) plan, budget, and
position their resources to respond to these various threats.
* Sustainability concerns:
Current fiscal and environmental policies are clearly unsustainable.
The $248 billion deficit forecast for fiscal year 2006, the anticipated
growth of spending on social insurance programs, and the potential tax
gap resulting from the changing nature of the economy will erode the
ability of government to respond to the needs of U.S. citizens over the
long term. The growing awareness of the effect of climate change on the
environment and the economy and concerns about quality of life add a
new layer of complexity to the already difficult question of how to
sustain economic growth when components of that growth—factories, cars
and trucks, fertilizers, and electricity-generating plants—often
adversely affect air and water quality and can change climates in
potentially catastrophic ways.
* Economic growth and competitiveness:
Economic growth and competition are also affected by the skills and
behavior of U.S. citizens, the policies of the U.S. government, and the
ability of the private and public sectors to innovate and manage
change. The U.S. education system must prepare the workforce by
providing the necessary skills and knowledge to drive innovation,
productivity, and economic growth while enabling the United States to
continue to improve its standard of living and competitive posture.
Importantly, the saving and investment behavior of U.S. citizens
affects the capital available to invest in research, development, and
productivity enhancement. And the tax and regulatory policies of the
U.S. government affect its economic growth and ability to compete. The
U.S. economy benefits from less restrictive labor and product market
regulation and lower tax burdens than those of many other Organization
for Economic Co-operation and Developement countries, although
deregulation can present its own challenges and requires oversight to
protect the public interest.
* Global interdependency:
Economies as well as governments and societies are becoming
increasingly interdependent as more people, information, goods, and
capital flow across increasingly porous borders. Indicators like
international trade and financial transactions reveal how economic
activity has come to link nations. Both U.S. imports and exports as a
share of the gross domestic product (GDP) more than doubled from 1970
to 2005. The United States faces the challenge of securing its borders
to protect the safety and security of the nation without impeding the
exchange of people, ideas, goods, and capital needed to sustain
economic growth and to strengthen society. And transportation
systems—highway, rail, and air—as well as immigration and employment
policies and practices may require modifications to support these
changes.
* Societal change:
The U.S. population is aging and becoming more diverse. As U.S. society
ages and the ratio of elderly persons and children to persons of
working age increases, the sustainability of social insurance systems
will be further threatened. Specifically, according to the 2000 census,
the median age of the U.S. population is now the highest it has ever
been, and the baby boomer age group—people born from 1946 to 1964,
inclusive—was a significant part of the population. As this group ages,
it will have a continuing influence on society and social programs.
* Quality of life:
Concerns about the sustainability of the nation’s resources and current
U.S. policies represent threats to the quality of life of U.S. citizens
and of other people around the globe. Despite increasing productivity
and economic growth, U.S. citizens increasingly face income insecurity
and a growing gap between the haves and the have nots. Lack of
affordable housing leading to urban sprawl and growing commute times
leave many Americans struggling to balance the demands of work and
family.
* Science and technology:
Science and technology offer many possibilities for improving people’s
quality of life. These areas hold the promise of future productivity
gains and economic growth. However, with opportunities come challenges,
such as ensuring cybersecurity, protecting personal privacy, and
preserving tax bases for state and other governmental entities. The
proliferation of information on the Internet, for example, has helped
break down borders and has increased our nation’s global
interdependence. However, safeguards on the quality of information are
few. At the same time, the possibilities suggested by advances in
science and technology, especially in areas such as medicine, raise
ethical and moral questions that society must confront.
Source: See Image Sources.
[End of table]
Goal 1: Provide Timely, Quality Service to the Congress and the Federal
Government to Address Current and Emerging Challenges to the Well-being
and Financial Security of the American People:
In keeping with GAO’s mission to support the Congress in carrying out
its constitutional responsibilities, our first strategic goal focuses
on several aspirations of the American people that were defined by the
founding fathers to “establish justice, insure domestic tranquility, …
promote the general welfare, and secure the blessings of liberty” for
U.S. citizens now and in the future. The nation’s aging and more
diverse population and rapid technological change and Americans’ desire
to improve quality of life have major policy and budgetary implications
for the federal government. In particular, growing commitments to the
elderly will crowd the capacity of a smaller generation of workers to
finance the competing needs and wants brought to the federal doorstep.
The first goal in this plan, therefore, continues to be to help the
Congress and the federal government address the challenges that affect
the well-being and financial security of the American people. The
stakes involved with the federal policies and programs covered under
goal 1 are high, as the benefits have become critical to the well-being
of families, businesses, state and local governments, and other key
sectors of the nation’s economy and society. Moreover, as the nation
moves to address the challenges of homeland security, it is becoming
apparent that a wide range of domestic policies and programs are
relevant to protecting the nation against terrorist threats. The
continuing presence of budget deficits should prompt greater scrutiny
of the performance and costs of many of these programs, and we expect
to be a major contributor to these debates through our audit and
evaluation work.
Our objectives for this goal are to support congressional and federal
efforts on:
1.1: the health needs of an aging and diverse population;
1.2: lifelong learning to enhance U.S. competitiveness;
1.3: benefits and protections for workers, families, and children;
1.4: financial security for an aging population;
1.5: ensuring a responsive, fair, and effective system of justice;
1.6: the promotion of viable communities;
1.7: responsible stewardship of natural resources and the environment;
and;
1.8: a safe, secure, and effective national physical infrastructure.
Strategic Objective 1.1:
The Health Needs of an Aging and Diverse Population:
Total health care spending in the United States from all sources—public
and private—continues to increase at a breathtaking pace. From 1990
through 2000, spending nearly doubled to over $1.3 trillion and by 2010
is estimated to more than double again to almost $2.9 trillion. (See
fig. 5.) This unrelenting growth is producing a health care sector that
continues to claim an increasing share of the nation’s gross domestic
product (GDP)—about 12 percent in 1990 versus an estimated 18 percent
in 2010 and 20 percent by 2015.
Figure 5: Total National Health Care Spending, Fiscal Years 1990, 2000,
and 2010:
This is a vertical bar graph depicting health care spending for fiscal
years 1990, 2000, and 2010. The vertical axis of the graph represents
dollars in trillions from 0 to 3.0. The horizontal axis represents the
fiscal years 1990, 2000, and 2010. Approximate spending is depicted as
follows:
1990: $0.7;
2000: $1.4;
2010: $2.8.
Source: Centers for Medicare and Medicaid Services.
Note: The dollar amounts for 1990 and 2000 are in nominal dollars; the
dollar amount for 2010 is projected.
[End of figure]
Not surprisingly, health care spending has been one of the most rapidly
rising elements of federal spending, growing three times faster than
the rest of the federal budget over the last quarter century. (See fig.
6.) Expenditures on health-related programs, one of the largest
components of federal spending, totaled $583 billion in fiscal year
2006, or about 22 percent of federal spending. Health care also
accounts for significant federal tax expenditures, with $132.7 billion
in forgone revenues projected for fiscal year 2006 because of employer
contributions to medical care and medical insurance. The cost pressures
of serving a growing population—particularly those 65 and older—are
compounded by scientific advances in medical treatments, which can blur
the lines between needs and wants and make it difficult to reasonably
assess what society can afford.
Figure 6: Growth of Federal Health Expenditures, Fiscal Years
1980–2006:
This is a line graph with two lines: Health outlays and All other
federal spending. The vertical axis of the graph represents percentage
increase since fiscal year 1980 from 0 to 1,000. The horizontal axis of
the graph represents fiscal years from 1980 to 2006. The line depicting
Health outlays rises from 0 in 1980 to approximately 900 in 2006. The
line depicting all other federal outlays rises from 0 in 1980 to
approximately 200 in 2006.
Sources: GAO (analysis) and Office of Management and Budget (data).
[End of figure]
Of particular concern is the growth in Medicare expenditures, which
totaled over $336 billion in 2005. Even without considering
the financial effects of its new prescription drug benefit, Medicare is
expected to more than double its share of the economy by 2030,
competing with other spending and economic activity of value. Indeed,
expenditures for hospital insurance, one component of Medicare,
exceeded hospital insurance income (exclusive of interest income) in
2004. This fiscal imbalance is projected to continue. Consequently, the
Hospital Insurance Trust Fund is projected to be depleted by 2018. Also
of concern are issues of (1) modernizing Medicare’s management
structure, payment policies and methodologies, and benefits package and
(2) reducing Medicare’s administrative burden on providers. Moreover,
because of its size and complexity, Medicare is inherently difficult to
manage and is a target for fraud, waste, and abuse. Medicare claims
administration contracting is undergoing significant changes. In the
next 3 to 5 years, all of the contracts will be recompeted and much of
the claims administration workload will be transferred to about half
the number of current contractors—an undertaking on a scale unlike
anything Medicare has experienced before. Consequently, effective
oversight is critical to protecting program dollars and promoting
efficient program operations.
Although the introduction of competitive principles to health care
helped to contain medical care cost increases for several years, costs
continue to rise, as do the number of Americans without health
insurance. These cost increases have important implications for federal
health care programs and outlays and for the availability of employer-
sponsored health insurance. Many employers reportedly have been
considering or made changes to decrease the generosity of their health
insurance benefits, or have shifted risk to employees in the form of
health plans with significantly higher deductibles, sometimes coupled
with health savings accounts. Moreover, the public is concerned about
the quality of care, consumer protection mechanisms, and the
availability of information to allow purchasers to make informed
insurance choices.
The government also must address pressing issues in its own health care
delivery systems. The Department of Veterans Affairs (VA)—one of the
nation’s largest health care delivery systems—spends about $30 billion
a year to provide health care to approximately 4.9 million of the
almost 7.7 million veterans enrolled for VA care. VA provides this care
using a physical infrastructure that is, in many instances, obsolete
and burdened with excess capacity for inpatient care. The Department of
Defense’s (DOD) health care system will spend about $38 billion in
fiscal year 2006 to provide health care to over 9 million eligible
beneficiaries who receive health care provided directly by DOD or
through DOD purchase of health care from civilian providers. Because of
potential complementary aspects of the DOD and VA health care delivery
systems, pressure is mounting to integrate aspects of the two systems
to increase the efficiency and effectiveness of federal health care
delivery, including improvement in the process for veterans returning
from Iraq and Afghanistan who transition from DOD to VA health care.
Other areas of concern are the efficiency and effectiveness of the
government’s public health programs, including those administered by
the National Institutes of Health, Food and Drug Administration,
Centers for Disease Control and Prevention, Health Resources and
Services Administration, Substance Abuse and Mental Health Services
Administration, and Indian Health Service. These programs include those
that support and conduct research on infectious and chronic diseases
and disabilities or provide grants to states and nonprofit
organizations for conducting public health activities, such as mental
health and substance abuse prevention and treatment services; for
reducing risk factors for potentially disabling conditions such as
heart disease, stroke, and diabetes; and for operating health care
safety net facilities. The Food and Drug Administration also conducts
regulatory oversight of the United States’ drug and medical device
industries.
In recent years, threats to the public health, such as Hurricane
Katrina, severe acute respiratory syndrome, and the potential for
pandemic influenza, have posed significant challenges for the
government. The threat of terrorists using biological weapons of mass
destruction, such as anthrax and smallpox, has raised similar concerns
about the nation’s ability to adequately respond to bioterrorist
attacks. Awareness of these public health threats has heightened
concern about disease surveillance systems (both domestic and
international); the surge capacity of the health care system (including
hospital beds and equipment, trained personnel, and laboratories); and
coordinated communication systems among federal, state, and local
emergency responders. Greater attention has been given to federal,
state, and local efforts to develop coordinated plans for dealing with
public health emergencies and to develop emergency response systems
linking hospitals, emergency rooms, health personnel, and fire and
police efforts to respond to any public health threat.
Finally, the baby boom generation will undoubtedly place increasing
pressure on the Medicaid program for which joint federal/state
expenditures are estimated to be $326 billion for fiscal year 2005.
Medicaid helps to pay for nursing home and other community-based forms
of long-term care services. Yet meeting an increasing demand for such
services at a time when many states are recovering from financial
difficulty and the federal government is once again operating at a
deficit will pose significant challenges for federal and state decision
makers, with important implications for the services offered by each
state. At the other end of the population spectrum are millions of
uninsured children whose families have no health insurance. Medicaid
and the State Children’s Health Insurance Program (SCHIP) help cover
the health insurance costs of these low-income Americans. However, as
state revenues continue to recover from the most recent economic
downturn, Medicaid costs continue to rise, thus prompting states to
find new ways to contain program spending. In considering
reauthorization of SCHIP in 2007, it will be important to examine state
experiences implementing SCHIP and whether the program has met the
legislation’s original goal to reduce the number of uninsured children.
Accounting for and overseeing these two programs represents a
formidable challenge for the federal government because of the
variation in state policies, procedures, and delivery systems. In
particular, Medicaid’s size and complexity make it vulnerable to fraud,
waste, and abuse, making effective federal oversight critical.
To support efforts by the Congress and the federal government to
address these issues, we will use the following performance goals:
1.1.1: evaluate Medicare reform, financing, and operations;
1.1.2: assess trends and issues in private health insurance coverage;
1.1.3: assess actions and options for improving VA’s and DOD’s health
care services;
1.1.4: evaluate the effectiveness of federal programs to promote and
protect the public health;
1.1.5: evaluate the effectiveness of federal programs to prevent,
prepare for, and respond to public health emergencies;
1.1.6: evaluate federal and state program strategies for financing and
overseeing long-term health care; and;
1.1.7: assess state experiences and federal oversight in providing
health insurance coverage for low-income populations.
Performance Goal 1.1.1:
Evaluate Medicare Reform, Financing, and Operations:
Medicare now finances health care for over 40 million Americans,
accounting for almost one-eighth of all federal expenditures. Even
without considering the financial effects of the new prescription drug
benefit, Medicare is expected to more than double its share of the
nation’s economy by 2030, crowding out other government spending and
economic activity. Medicare’s Hospital Insurance Trust Fund essentially
began running a cash deficit in 2004 and is projected to become
insolvent in 2018. The 2003 Medicare legislation did provide for the
phase-in of several reforms to help restrain program spending growth,
including reforms that seek to encourage price competition among
Medicare health plans and among suppliers. It also included a reform
that provides an incentive for beneficiaries to make cost-effective
choices among Medicare’s health plans. These reforms, while steps in
the right direction, will not be sufficient to avert Medicare’s fiscal
crises. Fundamental, structural program reforms will be necessary to
ensure Medicare’s long-term sustainability.
Any structural changes will take time to fully implement. Therefore, it
is imperative to continue to concentrate on improving the existing
program and refining Medicare’s payment methods in ways that reward
fiscal discipline while preserving access to care. Effectively managing
the Medicare program, including safeguarding its integrity, remains a
continuing challenge, in part because of the program’s size and
complexity. Since 1990, we have designated Medicare as a high-risk
program, vulnerable to waste, fraud, abuse, and mismanagement. Because
Medicare currently pays out over $336 billion annually and is
responsible for financing health services delivered by over 1 million
providers, it is an especially attractive target for fraud, waste, and
abuse, and therefore good management is critical.
Key Efforts:
* Analyze Medicare’s financial condition and the potential consequences
of program structural reforms;
* Evaluate the Centers for Medicare & Medicaid Services’ management of
Medicare, including its implementation of legislative reforms and its
service to providers and beneficiaries;
* Evaluate Medicare payment methods for health care providers and
plans;
* Assess the effects of Medicare’s payment methods on access to, and
quality of, health care services;
* Evaluate the Centers for Medicare & Medicaid Services’ safeguards and
program controls over provider and plan payments, beneficiary access,
and quality of health care services.
Potential Outcomes:
* Better congressional understanding of Medicare’s financial condition
and program reform proposals, including implications for the budget and
for health care;
* Improvements in the Centers for Medicare & Medicaid Services’ program
management and implementation of legislated Medicare program changes;
* Development of more comprehensive, accurate, and timely data for
evaluating program performance and services to beneficiaries;
* Medicare payment methods that minimize federal costs and promote
access to quality medical care;
* Reductions in improper payments to health care providers and plans
and in unnecessary program expenditures.
Performance Goal 1.1.2:
Assess Trends and Issues in Private Health Insurance Coverage:
Private health insurance provided coverage for more than 198 million
Americans in 2004; however, nearly 46 million individuals did not have
health insurance. The federal government has an increasing role in
overseeing employer-sponsored health benefits and private insurance
coverage both through its traditional roles established by the Employee
Retirement Income Security Act of 1974 and the tax code and through
more recent federal insurance standards, such as the Health Insurance
Portability and Accountability Act of 1996, and tax incentives, such as
health insurance tax credits for displaced workers in the Trade
Adjustment Assistance Reform Act of 2002.
The Congress continues to consider additional approaches to increase
private health insurance coverage, such as new tax incentives for
individuals who are unemployed or do not have coverage through their
employers or purchasing arrangements for small employers. Such new
approaches may increase access to health insurance for some individuals
or employers but need to be carefully assessed for their budget
implications, effects on those already purchasing coverage, and need
for effective regulatory oversight.
Strong interactions exist between the private health insurance market
and public health insurance programs, including Medicare and Medicaid,
with financing innovations in the private or public sector often being
adopted by the other sector. The Federal Employees Health Benefits
Program, which provides health insurance to more than 8 million federal
employees, retirees, and dependents, has sometimes been considered a
model for other large employers or public programs, but has also had to
address issues of increasing costs. For example, like many private
employers, the Federal Employees Health Benefits Program has introduced
new so-called “consumer directed health care plans,” such as those
coupled with health savings accounts. The impact these new plans will
have on cost, access, and quality of health care is currently unknown.
Recent expansion of the Medicare benefit to include outpatient
prescription drug coverage affects employers that provide health
coverage for their retirees as they may redesign their benefits to
coordinate with the Medicare coverage or receive a federal subsidy to
maintain primary drug coverage. In addition, the federal government
began offering long-term care insurance to employees, retirees, and
their families in 2002, which has contributed to the further
development of the private long-term care insurance market. Thus far,
this market has played a relatively small part in financing long-term
care services compared to public programs. However, increases in
consumer purchases of long-term care insurance could help decrease
future demands on Medicaid for such care.
The impact of public and private efforts to contain costs or improve
access in one sector may lead to unintended consequences for the other.
These complex interrelations between federal policy and the private
health insurance market greatly affect the affordability, availability,
and quality of insurance coverage that most Americans receive.
Key Efforts:
* Analyze potential modifications to federal tax policies and new
insurance purchasing arrangements for their impact on the numbers of
uninsured, costs of health care services, and implementation challenges
for federal and state agencies;
* Evaluate trends in, and distribution of, health insurance coverage,
including long-term care insurance and employer sponsorship of private
health insurance for employees and retirees;
* Analyze the coverage and affordability of products available to
consumers in the individual insurance and small group insurance
markets;
* Assess the impact of public and private agencies’ efforts to achieve
compliance with federal and state health insurance standards.
Potential Outcomes:
* Better congressional understanding of proposals to alter tax
treatment of health care insurance costs and to establish new health
insurance purchasing arrangements;
* More complete congressional understanding of trends in health and
long-term care insurance, including changes in private health insurance
coverage and the evolving health and long-term care insurance markets;
* Better congressional understanding of the impact of public and
private efforts to achieve compliance with federal health insurance
standards.
Performance Goal 1.1.3:
Assess Actions and Options for Improving VA’s and DOD’s Health Care
Services:
VA and DOD operate two of the largest health care systems in the world,
together spending about $68 billion a year for health care. Both
systems face great challenges in an era of growing demand for health
care and increasing fiscal pressures. For instance, VA operates and
maintains a large portfolio of aged health care assets, primarily
buildings, which were built when greater emphasis was placed on
inpatient care than today. These buildings are not effectively aligned
with VA’s new health care delivery model, which emphasizes outpatient
care delivered closer to where veterans live. VA has opened hundreds of
community-based outpatient clinics to increase the number of veterans
who have reasonable geographic access to VA-provided outpatient care.
As a result of multiple factors, including VA’s new health care
delivery model, the influx of new veteran enrollees because of relaxed
eligibility standards, and the return of veterans from Iraq and
Afghanistan, VA faces difficult realignment decisions involving
resource allocation, capital investments, consolidations, closures, and
contracting with local health care providers. These may have
significant ramifications for stakeholders, such as medical schools and
unions, and for the use of VA’s existing resources, primarily because
realignments involve shifting the workload among delivery locations.
Similarly, DOD faces pressures to adapt its health care structure
because of changing military threats; a decreased force size; expanded
benefits; and an evolving health care marketplace, characterized by
rising costs and increasing beneficiary concerns about access.
Beneficiaries include active duty, reserve, and retired servicemembers
and their dependents. In response to long-standing issues faced by
DOD’s health care system, DOD established its nationwide managed care
program, TRICARE, in the mid-1990s. However, beneficiary concerns have
continued under TRICARE, as have concerns about the efficiency of the
program. Further, concerns have been raised about rising program costs,
and beneficiaries continue to complain about poor access to care. These
concerns have led DOD to propose increases to some TRICARE fees, co-
payments, and deductibles to promote cost sharing and focused attention
on the need for DOD to identify cost reduction measures and alternative
approaches for delivering health care.
Key Efforts:
* Evaluate proposals to restructure or consolidate VA’s health care
system, including proposals on capital asset realignment and resource
sharing;
* Assess implications of changes to VA and DOD health benefits and
health care delivery systems;
* Examine VA and DOD efforts to provide care and seamless transition
for veterans returning from Iraq and Afghanistan;
* Assess vulnerability of VA’s system to fraud, waste, and abuse;
* Examine access to and quality and cost of care provided to VA and DOD
beneficiaries;
* Review implementation of VA resource allocation and revenue
collection systems and budget formulation and execution practices;
* Examine DOD’s efforts to contain and share costs of expanded benefits
for active duty, reserve, and retired beneficiaries.
Potential Outcomes:
* More effective and efficient organizational structures and service
delivery for both VA and DOD;
* Improved understanding of how potential changes affect costs,
utilization of services, and retention;
* Reductions in unnecessary health care expenditures;
* Better understanding of factors that explain VA and DOD variations in
access to, quality of, and timeliness of care and patient safety;
* Improved VA budgeting and resource allocation systems that more
adequately reflect workload and costs and promote efficiency and
optimization;
* Better understanding of DOD’s costs and how they are affected by
beneficiary fees and co-payments.
Performance Goal 1.1.4:
Evaluate the Effectiveness of Federal Programs to Promote and Protect
the Public Health:
To promote and protect the health of the nation, public health agencies
pursue a broad range of activities that tangibly affect the well-being
of every American. These include conducting public health surveillance
on new and emerging infectious diseases, nationally and
internationally; sponsoring and conducting biomedical research;
evaluating the effectiveness and safety of pharmaceuticals and medical
devices; leading efforts to address infectious and chronic diseases;
increasing the availability of health services and health care
providers for medically underserved populations; and funding treatment
services for people with mental health conditions. Over 90 percent of
the National Institutes of Health’s annual budget of almost $29 billion
funds biomedical research, contributing to a dramatic increase in the
number of new medical treatments. New technologies and therapies will
further test the ability of the Food and Drug Administration to ensure
the safety and efficacy of new medical products while not unduly
delaying the availability of new products to consumers. Federally
funded health centers increase access to preventive and primary health
care for medically underserved Americans, including many who are poor
or lack health insurance. These safety net and other public health
organizations can help improve health outcomes, particularly for people
with chronic conditions, such as diabetes and hypertension, and are
making efforts to eliminate racial and ethnic disparities in health. In
recent years, there has been increased recognition that many families
are affected by mental illnesses and that there are greater
opportunities to treat people with these conditions and help them lead
productive lives in their communities. There is also growing attention
to the important role that health information technology can play in
improving the delivery of health care services.
Key Efforts:
* Evaluate impediments and barriers to the development of new
prescription drugs and vaccines;
* Assess the regulatory structure for ensuring the safety and efficacy
of medical devices, drugs, and other medical products and therapies;
* Evaluate programs targeted at improving the health status of the
population;
* Evaluate the effectiveness of programs to provide prevention,
treatment, and other services related to mental health conditions,
including substance abuse.
Potential Outcomes:
* Improved medical therapies and preventive measures, including
vaccines;
* More effective and efficient determination of the safety and efficacy
of medical products by the Food and Drug Administration;
* Greater access to preventive and primary health care services,
including for medically underserved populations, resulting in improved
health status;
* More effective programs for prevention and treatment of mental health
conditions, including substance abuse, allowing people with these
conditions to function better in their work and relationships.
Performance Goal 1.1.5:
Evaluate the Effectiveness of Federal Programs to Prevent, Prepare for,
and Respond to Public Health Emergencies:
The changing nature of public health threats—including emerging
infectious diseases like severe acute respiratory syndrome and a
potential pandemic influenza—requires effective surveillance and prompt
action by the Centers for Disease Control and Prevention and other
public health agencies at international, federal, state, and local
levels. The use of anthrax as a weapon of terrorism in 2001 heightened
concern over the public health threats posed by biological terrorism
and raised worries that the nation is not adequately prepared to
respond to bioterrorist attacks. Similarly, disasters such as the
attack on the World Trade Center and Hurricane Katrina have highlighted
the need to effectively plan for events that can disable a regional
health care system or cause widespread acute or chronic physical and
mental health problems. To improve the nation’s preparedness, federal
agencies engage in a number of activities aimed at improving planning,
detection, treatment, and response, and the Congress has substantially
increased funding for these programs. These activities include public
health surveillance systems to identify disease outbreaks, development
of technologies to more rapidly detect and diagnose infectious agents,
improved communication systems to facilitate sharing information on
disease outbreaks, and plans for increasing the surge capacity of the
health care system and ensuring that the emergency and trauma care
systems can address national needs.
Federal funding, primarily through the National Institutes of Health,
has recently been increased for the development of vaccines,
antibiotics, and antivirals to treat emerging pandemic diseases and
diseases that could result from bioterrorism. The Department of Health
and Human Services is also expanding the Strategic National Stockpile
of essential drugs and equipment that could be deployed to the scene of
an outbreak. The Department of Health and Human Services also has
recently released its comprehensive plan for a medical response to an
influenza pandemic. Several federal agencies provide funding to state
and local governments for response planning, offer training for
emergency response, fund equipment purchases, and maintain response
teams that can be deployed in the event of an attack. However, concerns
remain that funding may not be directed to the areas of greatest need.
Key Efforts:
* Evaluate the ability of federal public health agencies to detect and
counter emerging threats to the nation’s health;
* Evaluate the effectiveness of federal programs in ensuring the
preparedness of state and local governments for the public health and
medical consequences of a public health emergency;
* Evaluate identified needs and associated cost projections for
federally funded efforts at state and local government levels to
improve public health surveillance, training, communication systems,
and laboratories for public health preparedness;
* Evaluate the development and acquisition of vaccines and other
treatments for biodefense.
Potential Outcomes:
* Improved federal agency efforts to counter emerging public health
threats;
* More effective programs to assist state and local government
preparedness efforts;
* More effective and efficient allocation of resources for addressing
state and local government needs;
* Improved access to essential vaccines and other treatments.
Performance Goal 1.1.6:
Evaluate Federal and State Program Strategies for Financing and
Overseeing Long-term Health Care:
The aging of the baby boomers, combined with medical advances that are
contributing to longer life expectancies, will lead to a tremendous
increase in the elderly population over the next three decades. In
particular, there will be a substantial increase in the number of
individuals 85 and older, many of whom will require long-term care
services. Financing these services—within the context of evolving
service needs and alternative settings for receiving long-term care
services—will be a challenge for the baby boomers, their families, and
federal and state governments.
Medicaid contributes the most for long-term care, covering at least
some of the costs for two-thirds of nursing home residents, followed by
private expenditures. Many individuals become impoverished, and thus
eligible for Medicaid, by “spending down” their assets. Taken together,
Medicaid, Medicare, and other public programs contributed about 70
percent of the $193 billion spent on nursing home and home health care
in 2004. Private insurance (including long-term care insurance as well
as services paid by traditional health insurance) accounted for about
10 percent, with the remainder paid by the elderly, the disabled, or
their families.
The long-term care expenditures for the elderly are disproportionately
used to purchase nursing home care. There is growing emphasis, however,
on delivering services in the community rather than in nursing homes
and other institutional settings—not only to the younger disabled but
also to elderly individuals. The highly vulnerable nature of the long-
term care population underscores the importance of oversight to ensure
that providers comply with federal and state quality standards.
Key Efforts:
* Examine nursing homes’ compliance with federal and state quality
standards, including the adequacy of federal and state oversight and
resources;
* Review federal requirements and standards and their use to ensure
quality care in community-based, long-term care settings, such as home
health arrangements, assisted living facilities, and adult day care;
* Analyze public and private payment sources and strategies that
finance the continuum of long-term care, including integrated programs
for elderly or disabled beneficiaries who are dually eligible for
Medicare and Medicaid.
Potential Outcomes:
* Improved quality of care in nursing homes;
* Improved public and private awareness of alternatives to traditional
long-term care settings and the federal role in ensuring quality care.
Performance Goal 1.1.7:
Assess State Experiences and Federal Oversight in Providing Health
Insurance Coverage for Low-Income Populations:
Two jointly funded federal-state programs that provide health insurance
to low-income Americans are vulnerable to the cyclical nature of the
economy and to the problems of exploitation endemic to large government
programs. Medicaid is a means-tested entitlement program that provides
health care coverage to over 50 million low-income individuals. SCHIP,
which was created in 1997, provides health insurance to uninsured
children whose families’ incomes are too high to qualify for Medicaid.
As SCHIP is scheduled for reauthorization in 2007, congressional
leaders will not only consider state experiences implementing SCHIP but
also whether the program has met the legislation’s original goal to
reduce the number of uninsured children.
In the economic downturn from 2000 to 2002, states were faced with
declining revenues and, with respect to their Medicaid programs,
increased enrollment of nearly 9 percent per year from 2000 to 2003. In
response to this fiscal crisis, states curtailed enrollment, reduced
benefits, and increased beneficiary cost-sharing requirements in an
effort to contain costs. While many states have recovered from this
downturn and Medicaid spending has slowed, program costs continue to
outpace growth in states’ revenues. As states and the federal
government look for ways to realize Medicaid savings, the recently
enacted Deficit Reduction Act of 2005 provides new state flexibility to
increase beneficiary cost-sharing requirements and reduce Medicaid
benefit packages. With this flexibility, the act is expected to reduce
federal Medicaid spending by $4.8 billion from 2006 to 2010 and by
$26.1 billion from 2006 to 2015; however, this reduced spending may
adversely affect access to care for these vulnerable populations.
Federal oversight continues to be essential to ensuring the programs’
financial and operational integrity. The challenges inherent in
overseeing a program of Medicaid’s size, growth, and diversity,
combined with the open-ended nature of the program’s federal funding,
puts the program at high risk for waste and exploitation. We added
Medicaid to our 2003 list of high-risk programs and have focused our
work on strengthening the program’s operations. Our work shows, for
example, that the federal government has been vulnerable to
questionable state Medicaid financing practices, through which some
states have generated excessive federal payments without paying their
fair share or without assurances that the payments are for covered
Medicaid services. The Deficit Reduction Act’s establishment of a
Medicaid Integrity Program as well as other provisions designed to
increase the Centers for Medicare & Medicaid Services’ level of effort
to support state activities to address fraud, waste, and abuse in
Medicaid are further recognition of the need to address systemic
financial weaknesses.
In addition, vigilance must be maintained regarding the appropriateness
of allowing states to enhance their flexibility in identifying eligible
populations and increasing cost sharing for beneficiaries eligible for
Medicaid and SCHIP. Our work further shows that some of the federally
approved waivers are inconsistent with statutory authority or long-
standing administration policy. Federal oversight must balance support
of state flexibility in designing and implementing states’
programs—which can vary greatly in terms of eligibility rules, benefits
offered, and delivery systems—with the need to ensure the appropriate
use of federal funds to meet the statutory and regulatory requirements
of both programs.
Key Efforts:
* Assess Medicaid and SCHIP coverage for vulnerable populations,
including chronically ill, elderly, and disabled populations;
* Evaluate Medicaid and SCHIP access to and use of services under
different service-delivery systems, payment methodologies, and cost-
sharing practices;
* Evaluate federal oversight of states’ implementation of Medicaid and
SCHIP, including ensuring fiscal integrity and the appropriate use of
authority to waive certain statutory provisions.
Potential Outcomes:
* Greater access to services for eligible beneficiaries;
* More efficient and effective delivery of services;
* Improved accountability and oversight of federal-state health
financing programs serving low-income populations.
Strategic Objective 1.2:
Lifelong Learning to Enhance U.S. Competitiveness:
Ensuring that people of all ages have the opportunity to continue to
learn throughout their lifetimes has long been regarded as critical to
the continued vitality of this democratic society and to its long-term
ability to compete in a global marketplace. To this end, the federal
government invests more than $89 billion per year in programs that
foster the development, education, and skill attainment of children and
adults of all ages. These programs include those targeted to the very
young, such as child care and early childhood education; those serving
primary and secondary school children; and higher education and
employment assistance programs that serve working-age adults. The
federal government’s involvement in programs and policies that promote
lifelong learning is becoming increasingly important in light of recent
trends in workforce demographics and changes in the global economy. For
example, immigrants, both legal and illegal, are having a profound
effect on U.S. schools, businesses, and social service programs. Our
nation’s ability to provide this population of children and adults with
the English language and academic skills they need to live as U.S.
citizens above the poverty line will contribute greatly to our nation’s
economic success. Moreover, as the demographics of the workforce change
and globalization increases, it will become even more important for
Americans to have the flexibility and skills to adapt to the changing
economic environment. As a result, it will be critical that the
Congress and the federal government have reliable information on how
efficiently and effectively federal funds are being used to provide or
augment educational and lifelong learning opportunities, particularly
among those most in need of help; how well federal programs are
achieving their objectives and meeting the needs of the 21st century
workforce; and how the management and oversight of these programs can
be improved.
The federal government has long had a central role not only in funding
child care, education, and employment services, but also in shaping
national education policy and ensuring that those most in need of help
have access to educational and employment opportunities. Federal
investment in child care has been growing, in part to support low-
income mothers who have entered the workforce after welfare reform. In
fiscal year 2005, the federal government invested over $13 billion in
early childhood education and care programs for young children. In
addition, Americans have placed a high priority on educating their
school-age children and preparing them to become self-sufficient adults
and productive workers. The federal investment in elementary and
secondary education has increased from over $20 billion in fiscal year
2000 to about $37 billion in fiscal year 2005. Beyond providing for
basic educational needs, a competitive national economy depends, in
part, on effectively preparing workers to compete in the labor force.
In fiscal year 2005, the Department of Education invested over $33
billion in vocational education, adult education, and student financial
aid.
Over the past half century, American demographics and the economy have
undergone significant changes, increasing the demand for early
childhood education and care as well as a more highly educated and
skilled workforce. As labor force participation has increased among
women, including mothers of young children, the availability of early
childhood education and care has become increasingly important. At the
same time, the aging of the American population will put additional
demands on the productivity of the working-age population, increasing
the demand for a more educated workforce. Researchers warn that unlike
in the past when economic growth was fueled in part by increases in the
size and skill of America’s workforce, over the next two decades the
potential for shortages of skilled workers could present mounting
challenges for productivity and economic growth. Since 1940, the share
of the nonfarm labor force composed of managers and professionals has
increased by more than 50 percent while the share made up of manual
production employees, laborers, and craftspeople has fallen by nearly
half. (See fig. 7.) A focus on developing and maintaining a flexible,
highly skilled workforce will be critical to ensuring our nation’s
economic competitiveness.
Figure 7: Percentage of Nonfarm Labor Force by Occupation:
[See PDF for image]
This is a line graph with two lines: Manufacturing, trade and services;
and Management and Professional. The vertical axis of the graph
represents percentage of total nonfarm labor force from 0 to 80. The
horizontal axis represents fiscal years from 1940 to 2005.
Source: GAO (analysis) and the Bureau of Labor Statistics (data).
[End of figure]
To meet these challenges, discussions of upcoming legislation affecting
key education and employment programs emphasize the increased
importance of targeting federal resources strategically to achieve
desired outcomes and managing these programs efficiently and
effectively. For example, as the Congress considers reauthorizing the
Head Start program, discussions have centered on provisions to increase
coordination between Head Start and other early childhood programs and
to increase teacher qualifications, among others. The No Child Left
Behind Act of 2001, which is due to be reauthorized in 2007, has
focused national attention on increasing accountability for states and
school districts to improve achievement for all students while
continuing the traditional focus of federal elementary and secondary
school programs that provide opportunities for children
from disadvantaged families. Helping states to meet these requirements
requires a larger role for the Department of Education in providing
leadership and oversight. The Higher Education Act, the Adult Education
and Family Literacy Act, and the Carl D. Perkins Vocational and
Technical Education Act are all due to be reauthorized in the near
future. The Congress will be debating several key issues, including the
role of federal grant and loan programs in increasing access to higher
education, institutional accountability for educational costs and
quality, how best to provide for a skilled workforce, and the
Department of Education’s management of the federal investment in
postsecondary education. Finally, the Congress has also begun work in
reauthorizing the Workforce Investment Act of 1998. Some of the issues
likely to be addressed include indicators of program performance and
funding flexibility. As these examples illustrate, the Congress and the
federal government continue to be challenged as they refine the
country’s education and employment programs to meet the needs of the
21st century economy.
To support efforts by the Congress and the federal government to
address these issues, we will use the following performance goals:
1.2.1: identify opportunities to improve programs that target federal
resources to activities that support lifelong learning;
1.2.2: assess the effectiveness of education and training programs in
meeting the needs of the 21st century workforce; and;
1.2.3: support improved oversight and management of education and
training programs.
Performance Goal 1.2.1:
Identify Opportunities to Improve Programs That Target Federal
Resources to Activities That Support Lifelong Learning:
The federal government invests more than $89 billion per year in
education and employment programs for children and adults to help them
to become self-sufficient and productive workers. To ensure the
efficient and effective use of these funds, many programs target
federal resources to disadvantaged or at-risk populations, including
those from poor families, with disabilities, or with limited English
proficiency.
In recent years, increasing emphasis has been placed on preparing
children to learn starting in early childhood. To that end, federal
resources devoted $13 billion to child care and early childhood
education in fiscal year 2005. The largest early childhood education
program, Head Start, had funding of over $6.8 billion in fiscal year
2005 and is targeted to low-income children. The federal government
also funds at least eight other programs that serve young children and
provides tax incentives for child care. In an era of scarce resources,
there is interest in ensuring that these funds are used effectively to
have the greatest impact. In ensuring that federal resources are
appropriately targeted, there continues to be concern about the cost,
coordination, and availability of child care and early childhood
education.
Americans have placed a high priority on educating children and
ensuring that all children have access to an education that will
prepare them to be productive citizens. Although most funding for
elementary and secondary education comes from state and local
resources, in fiscal year 2005 the federal government invested $38
billion in elementary and secondary education programs. Most major
sources of federal funding for elementary and secondary education are
targeted to disadvantaged or at-risk populations, including Title I of
the Elementary and Secondary Education Act (Title I), which is targeted
to low-income school districts and schools; special education programs
authorized by the Individuals with Disabilities Education Act; and the
Carl D. Perkins Vocational and Technical Education Act of 1998. In
addition, the No Child Left Behind Act of 2001 modified Title I
allocation formulas to increase targeting to high-poverty school
districts. As states move forward in improving their kindergarten
through 12th grade (K-12) education programs, it is important that the
federal government ensure that federal funds are appropriately targeted
to reach designated student groups.
To enhance U.S. competitiveness, the federal government has an interest
in promoting access to postsecondary education and lifelong learning.
The federal government’s investment in postsecondary education is
significant, but several factors confound the nation’s efforts to
support postsecondary goals. Students and their families face
escalating educational costs, postsecondary enrollments are projected
to increase in the next decade, and fiscal and budgetary pressures will
constrain the federal and state governments’ ability to support higher
education. In light of these challenges, it is critical that federal
resources be used effectively to expand access to higher education. To
that end, the federal government uses several tools to ensure access to
postsecondary education and lifelong learning, including Pell Grants,
student loans, tax benefits, state and local grant programs, funding to
improve the quality of institutions that serve high proportions of
minority and disadvantaged students, and funding to provide services to
help disadvantaged students to enter and complete college. In addition
to supporting a traditional college education, the Department of
Education and other agencies also administer programs for vocational
education, occupational training, and adult basic education that may
aid at-risk youth and other vulnerable populations’ transition to the
workplace.
Key Efforts:
* Evaluate the cost, coordination, and availability of child care and
early childhood education;
* Assess whether federal resources provided under the No Child Left
Behind Act are appropriately targeted to designated beneficiaries in K-
12 education programs;
* Assess the efficiency and effectiveness of programs designed to
promote access to and affordability of postsecondary education.
Potential Outcomes:
* More effective use of federal funds aimed at improving the
coordination and availability of child care and early childhood
education;
* Better targeting of federal resources to K-12 education programs
serving different types of at-risk students;
* Increased participation of disadvantaged students in postsecondary
education through more effective use of federal resources.
Performance Goal 1.2.2:
Assess the Effectiveness of Education and Training Programs in Meeting
the Needs of the 21st Century Workforce:
In recent years, the federal government has placed increased emphasis
on assessing the effectiveness of federally funded programs and
ensuring that they achieve their intended outcomes. While education,
starting in early childhood and continuing into adulthood, clearly
results in a more enlightened citizenry and strengthens the nation’s
democracy, it also demonstrably improves the nation’s workforce and the
quality of life for the nation’s workers. Yet, poor academic
achievement, poverty, and immigration challenge the nation’s ability to
prepare its citizens for living and working in the United States in the
21st century.
There is interest in measuring student outcomes and monitoring progress
in educational programs at all levels. In the area of early childhood
education and child care, federal initiatives emphasize the importance
of helping all children develop school readiness skills, including
early reading skills. Interest in assessing performance and outcomes
in this area contributed to our work on testing in the Head Start
program, teacher qualifications, and program data and monitoring. In
the area of K-12 education, there continues to be interest in how
schools are implementing the No Child Left Behind Act of 2001 and
measurement of outcomes. As required by the act, the states have
implemented standards-based assessments in reading and mathematics
to monitor performance outcomes and are working toward the goal of all
pupils reaching a proficient or higher level of achievement by the 2013
to 2014 school year. In the area of adult and vocational education and
employment programs, such as the Food Stamp Employment and Training
program and Trade Adjustment Assistance, a key issue is the extent to
which these programs are held accountable for achieving desired
results.In addition to improving performance and outcomes for all
students, federal initiatives have also included efforts to close
achievement gaps among disadvantaged populations. Students from ethnic
and racial subgroups, from poor families, with disabilities, or with
limited English proficiency generally have not performed as well as
other groups of children on tests. The No Child Left Behind Act of 2001
instituted new requirements to facilitate eliminating achievement gaps,
and policymakers are exploring ways to improve teaching and enhance
educational options in K-12 education. To facilitate eliminating these
achievement gaps in postsecondary education, the federal government
provides funding for services to help disadvantaged students not only
enter college, but also complete college.
Efforts to assess effectiveness of workforce development programs have
been increasingly focused on the extent to which these programs meet
the needs of employers in the face of increasing competition in the
global marketplace. The Workforce Investment Act of 1998 sought to
create a coherent nationwide service delivery system and shifted the
emphasis for federally funded workforce development services to
providing a full range of programs and services, including
postemployment training and assistance. However, there remain long-term
challenges to developing the sophisticated skills that employers
require and a slowing rate of growth in the number of workers entering
the workforce and attaining college degrees.
Key Efforts:
* Determine whether early childhood, education, and employment programs
are improving student performance and employment outcomes;
* Assess the impact of efforts to close achievement gaps among
disadvantaged populations in K-12 and postsecondary education
programs;
* Evaluate federal efforts to address employers’ changing needs for
workers.
Potential Outcomes:
* Greater assurance that the federal investment in early childhood,
education, and employment programs is improving student performance and
addressing current and future skill needs;
* Better congressional understanding of whether federal efforts to
close achievement gaps among disadvantaged populations are achieving
positive results;
* Enhanced ability of federal education and employment programs to meet
employers’ needs while enhancing the job opportunities, wage potential,
and job retention for America’s workers.
Performance Goal 1.2.3:
Support Improved Oversight and Management of Education and Training
Programs:
Ensuring adequate oversight and management of education and employment
programs is one of the federal government’s highest priorities. As
pressu