Family Planning Clinics Can Provide Services at Less Cost but Clearer Federal Policies Are Needed

HRD-81-68: Published: Jun 19, 1981. Publicly Released: Jun 19, 1981.

Additional Materials:

Contact:

Franklin A. Curtis
(202) 275-5451
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

In fiscal year 1980, the Department of Health and Human Services (HHS) spent about $375 million for family planning services and contraceptive supplies through several different programs. GAO reviewed several aspects of the family planning program authorized by the Public Health Service Act.

The family planning clinics reviewed generally provided the medical services required by HHS. However, HHS guidelines recommended or required too many clinic revisits by women using oral contraceptives, education that does not appear to be needed by all clients, and routine medical tests that do not seem to be necessary for all clients. Many of the clinics reviewed were performing tests and examinations not required by HHS or professional medical standards. Some of these HHS policies and clinic practices unnecessarily add to program cost and contribute to long waits for appointments and long office visits at some clinics, perhaps deterring initial or continuing participation in the program. Clinics have lost revenue and, in some cases, have treated clients inequitably because HHS and state policies were not clearly understood or consistent. HHS has failed to: (1) update its official definition of a low-income family; (2) issue guidance on charging fees to teenagers; and (3) uniformly enforce fee requirements. The adequacy of the management information system used to allocate program funds and monitor the program is questioned by many HHS and grantee officials.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: Congress has not addressed this recommendation in the more than 4 years that have passed since it was made. This recommendation was included in the GAO 1984 Annual Report and will be included in the 1985 Report. While GAO thought that it might be addressed in the 1985 reauthorization hearings, there are currently no plans for such hearings.

    Matter: Congress should reassess whether the Deputy Assistant Secretary for Population Affairs needs to administer all of the HHS family planning programs which provide for or authorize grants or contracts.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Health and Human Services should direct HHS regional offices to ensure that title X funded clinics establish fee scales and collect fees in accordance with title X regulations.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Health and Human Services should direct the Bureau of Community Health Services to revise its family planning guidelines to clarify clinics' options to tailor education requirements to client status and circumstances.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Not Implemented

    Comments: HHS believes that eligibility criteria for family planning services under title XX should be made at the state level. Title XX has been included in the Block Grant Program.

    Recommendation: The Secretary of Health and Human Services should take steps to resolve the differences between titles X and XX programs regarding eligibility for free and subsidized family planning service. If necessary, appropriate proposals should be prepared to achieve this.

    Agency Affected: Department of Health and Human Services

  4. Status: Closed - Not Implemented

    Comments: HHS believes that it is already providing Congress the necessary information on the type and results of research it supports.

    Recommendation: The Secretary of Health and Human Services should formally define program implementation research in consultation with the House Committee on Energy and Commerce and the Senate Committee on Labor and Human Resources.

    Agency Affected: Department of Health and Human Services

  5. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Health and Human Services should direct the Bureau of Community Health Services to revise its family planning guidelines to establish routine revisit policies in line with the American College of Obstetricians and Gynecologists' standards and recommendations.

    Agency Affected: Department of Health and Human Services

  6. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Health and Human Services should clarify the responsibilities of the Deputy Assistant Secretary for Population Affairs and instruct component agencies to cooperate with the Deputy to put the Deputy in a better position to coordinate all of the HHS family planning activities.

    Agency Affected: Department of Health and Human Services

  7. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Health and Human Services should direct the Bureau of Community Health Services to work with centers to prepare guidance on venereal disease screening appropriate for family planning projects. Such guidance should enable projects to decide, in consultation with state and local health authorities, whether to routinely test all clients or to apply criteria for selective testing.

    Agency Affected: Department of Health and Human Services

  8. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Health and Human Services should direct the Bureau of Community Health Services to revise its family planning guidelines to eliminate the proposed provision for routine gonorrhea screening and the existing requirement and recommendation for anemia screening and provide that clinics screen based on medical necessity or local conditions. Clinics desiring to screen all clients routinely should be required to justify the need to HHS.

    Agency Affected: Department of Health and Human Services

  9. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Health and Human Services should more closely monitor clinic practices to identify routine visits or medical services that are in excess of those required or recommended and deny federal financial participation under the title X, Medicaid, Social Services, and other programs for those activities unless they are appropriately justified.

    Agency Affected: Department of Health and Human Services

  10. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Health and Human Services should direct the Deputy Assistant Secretary for Population Affairs and the Office of Family Planning to refine existing management informations systems to provide data and performance efficiency indicators suited to family planning clinic operations. HHS should build on existing automated systems, and it should include, for example, objective and measurable standards for: (1) accurately counting workload; (2) reporting retention levels and degree of contraceptive protection provided; (3) total cost of providing services; (4) monitoring fee collections; and (5) the extent to which women served are priority target populations.

    Agency Affected: Department of Health and Human Services

 

Explore the full database of GAO's Open Recommendations »

Sep 15, 2016

Sep 14, 2016

Sep 12, 2016

Sep 9, 2016

Sep 6, 2016

Aug 31, 2016

Looking for more? Browse all our products here