Opportunity To Avoid Construction at Certain IHS Hospitals

HRD-82-122: Published: Sep 29, 1982. Publicly Released: Sep 29, 1982.

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GAO reviewed the factors that contributed to the low utilization of inpatient services at nine small Indian Health Services (IHS) hospitals and evaluated whether other cost-effective alternatives existed.

At the nine hospitals visited, GAO found that the inpatient workload was low and the services offered were limited when compared to those available at nearby community hospitals. Because of the limited inpatient services, a portion of the inpatient workload is referred to community hospitals which generally have the capacity to absorb the hospitals' total inpatient workload. The Department of Health and Human Services (HHS) plans to replace or modernize seven of the hospitals reviewed at a total estimated cost of $66 million. In addition, an estimated $6 million is to be used to correct structural deficiencies at all nine hospitals, and $15 million is to be used for construction of personnel quarters at four of them. GAO believes that some of the planned capital expenditures could be avoided by: (1) limiting expenditures to those required to maintain outpatient and emergency care facilities at the nine locations; and (2) obtaining inpatient care under contract from nearby community hospitals. The available cost data suggest that obtaining inpatient care for IHS beneficiaries from the community hospitals could be less costly. Discontinuing inpatient care at the hospitals may raise concern or opposition from tribal officials, and there may be some transition difficulties; however, phasing out IHS inpatient care by making greater use of community hospitals appears feasible as long as adequate funds for contract health care are available.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: Because none of the facilities has ever received a high enough priority to achieve a funding request level and because they have been excluded from active funding consideration for capital expenditures, IHS plans no further work on the recommendation.

    Recommendation: The Secretary, HHS, should require the Director, IHS, to reevaluate the hospital construction plans for each of the nine hospitals reviewed and justify any capital expenditures beyond those necessary to provide outpatient and emergency care facilities. The IHS justification should include a determination of: (1) the use of nearby community hospitals as a cost-effective alternative to IHS direct care, and (2) the impact of using community hospitals on the quality of Indian health care.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Not Implemented

    Comments: Because none of the facilities has ever received a high enough priority to achieve a funding request level and because they have been excluded from active funding consideration for capital expenditures, IHS plans no further work on the recommendation.

    Recommendation: The Secretary, HHS, should require the Director, IHS, to phase out the provision of IHS inpatient services by making greater use of nearby community hospitals where their use is a cost-effective alternative. The phaseout period should be long enough to assure IHS and tribal officials that inpatient care from nearby community hospitals will be both available and acceptable.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Not Implemented

    Comments: Because none of the facilities has ever received a high enough priority to achieve a funding request level and because they have been excluded from active funding consideration for capital expenditures, IHS plans no further work on the recommendation.

    Recommendation: The Secretary, HHS, should assure that IHS has sufficient contract health care funds available for inpatient care at community hospitals at locations where IHS inpatient care is being phased out or has been discontinued.

    Agency Affected: Department of Health and Human Services

 

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