Congressional Monitoring of Planning for Indian Health Care Facilities Is Still Needed

HRD-80-28: Published: Apr 16, 1980. Publicly Released: Apr 16, 1980.

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GAO studied the adequacy of the Indian Health Service's hospital planning activities. The Service is responsible for providing comprehensive health care to Indians and Alaska Natives. In May 1977, GAO reported to Congress that the Service's methodology for determining the number of hospital beds needed in the Navajo area would result in too many acute care beds. Because the Service used the same methodology for planning hospitals throughout its system, GAO estimated that similar problems probably existed elsewhere. Thus, the Appropriations Committees recommended, and Congress approved, a moratorium on the use of planning funds until the Service recognized the declining need for acute care beds. However, after the Service made some revisions to its planning procedures, Congress provided limited funding for two projects, the Chinle and the Talequah hospitals, that were being funded when the moratorium was imposed.

The Service's revised methodology appears to be a reasonable method for determining the need for acute care beds. However, the assumptions used in applying this methodology can result in overestimating or underestimating future demand. GAO believes the Service needs to further address the problems of availability and acceptability of health services in the Navajo area. Additionally, the revisions the Service made in its hospital planning and construction procedures are not completely responsive to the congressional directives. In an effort to limit cost overruns and make the Service's planning procedures more responsive, Congress has limited the number of acute care beds and the amount of gross square footage for the Chinle hospital. However, the Service has plans which call for a hospital and leased annex which, in total, will exceed the square footage limitation of the Chinle hospital, and estimates that construction costs on the Chinle hospital will exceed the original estimate by $6 million.

Matter for Congressional Consideration

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Matter: Congress should continue the funding moratorium until the Indian Health Service fully complies with the congressional directives to improve its hospital construction program.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of HEW should: (1) revise assumptions used in the planning methodology for the Service hospital projects; (2) limit construction of additional acute care beds to those for which the Service can demonstrate a need; (3) coordinate with the Bureau of Indian Affairs and consult with appropriate congressional committees before taking any action to relax Indian ancestry eligibility requirements for health services in the Oklahoma area; (4) improve routine and emergency transportation services for patients because the Service's plans for locating a hospital in each Navajo service area will not eliminate patients' transportation problems; (5) establish target dates for completing work on the Service's hospital planning proposals that have been mandated by Congress; (6) require that the Assistant Secretary for Health monitor progress in satisfying congressional directives and direct the Service to use a reliable system for identifying and giving priority to the most urgently needed Indian facilities; (7) direct the Service to develop a master plan for Navajo reservation health facilities, to revise the report on controls to prevent hospital project overruns, to construct the specified number of acute care beds and square footage for Service hospital projects at Chinle, Arizona, and to justify the size of the Tahlequah, Oklahoma, project; (8) assure that proposed Service submissions to Congress are independently reviewed and evaluated; and (9) explain in detail to Congress the circumstances surrounding the Chinle hospital design contract and the reasons for the escalation of construction cost estimates.

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