Health Systems Plans:

A Poor Framework for Promoting Health Care Improvements

HRD-81-93: Published: Jun 22, 1981. Publicly Released: Jun 22, 1981.

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The National Health Planning and Resources Development Act established health systems agencies (HSA) with responsibility for planning health services within a particular geographic area. The Act also established State health planning and development agencies and statewide health coordinating councils to deal with health care needs from the perspective of the entire State. The adequacy of health systems plans developed by HSA were reviewed and actions were recommended that the Department of Health and Human Services (HHS) should take to improve the plans.

A high priority of each HSA is to develop a health systems plan, a document describing what needs to be done to improve the health care system and the health status of area residents. The plan is fundamental for accomplishing the HSA objective. Despite substantial resources and community effort, GAO found that: (1) health systems plans were inadequately developed; (2) objectives lacked measurability; (3) objectives were not limited to priority goals; (4) many more objectives were established than could be accomplished within a reasonable timeframe; (5) objectives were questionable because they concerned further planning or were unattainable or unrealistic in what they sought to achieve through local community resources; (6) recommended actions for accomplishing objectives were nonexistent or poorly developed; and (7) resource requirements for implementing each recommended action were unspecified or inadequate. The failure of HSA's to follow HHS guidance and insufficient HHS involvement with HSA's during plan development contributed to the inadequacy of the plans. GAO also found that statewide roles for HSA vary widely and that the impact of the program is difficult to assess. This means that it may be impossible to produce clear and dramatic evidence concerning the effectiveness of health planning organizations.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: Because of budget reductions and program changes, there are no statewide health systems agencies operating. Therefore, the recommendation is no longer valid.

    Matter: Congress should amend the National Health Planning and Resources Development Act to allow the health planning organizations in States with statewide HSA's to jointly develop one health plan for the State.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: Statewide health systems agencies no longer exist, therefore, the recommendation is no longer valid.

    Recommendation: The Secretary of HHS should issue regulations and guidelines concerning the implementation of the health planning program in statewide HSA's that would include requiring written agreements between the statewide HSA and the State agency which set forth their respective roles in carrying out the joint planning process.

    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 HHS should require HSA's to revise inadequate plans so that such plans: (1) concentrate on a few significant objectives that can be achieved in a reasonable time frame; (2) specify a strategy for and organizations for accomplishing the objectives; and (3) identify the resources needed to carry out the objectives.

    Agency Affected: Department of Health and Human Services

  3. 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 HHS should require HSA's to actively pursue the implementation of health systems plans and annual implementation plans after plans are determined to be consistent with HHS guidance.

    Agency Affected: Department of Health and Human Services

  4. 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 HHS should actively work with HSA's during the development of future health systems plans to ensure that future plans do not contain the deficiencies currently existing.

    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 HHS should assess the adequacy of the latest health systems plan at each HSA.

    Agency Affected: Department of Health and Human Services

 

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