Health Care Shortage Areas:

Designations Not a Useful Tool for Directing Resources to the Underserved

HEHS-95-200: Published: Sep 8, 1995. Publicly Released: Sep 8, 1995.

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GAO reviewed the Department of Health and Human Services' (HHS) systems for identifying geographical areas where access to medical care is limited, focusing on: (1) how well the systems identify areas with primary care shortages; (2) how well the systems target federal funding to the underserved; and (3) whether the HHS proposal to combine the systems would lead to improvements.

GAO found that: (1) the two HHS systems do not reliably identify areas with primary care shortages or help target federal resources to the underserved; (2) the systems have widespread data and methodology problems which severely limit their ability to pinpoint needy areas; (3) both systems tend to overstate the need for additional primary care providers because they do not consider all of the categories of providers already in place; (4) the Health Professional Shortage Area System (HPSA) does not consider the extent to which available resources are being used; (5) the Medically Underserved Area System (MUA) is limited in its ability to identify underserved areas and populations; (6) neither system identifies the specific subpopulations that have difficulty obtaining medical care; (7) while the systems can sometimes accurately identify needy areas, they do not provide the necessary data to determine which programs are best suited to those areas; (8) the proposed consolidation and streamlining of the systems is not likely to solve system problems, since the underlying causes of the problems have not been addressed; (9) it may be more cost-effective to modify individual programs and application processes to identify where needs exist and the appropriate program to meet those needs and to target resources better; and (10) HHS officials believe that they need to maintain a national shortage designation system to monitor primary care access, but HHS has another initiative under way that could serve those purposes.

Matters for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: This recommendation has been superseded by a recommendation in GAO/HEHS-99-36.

    Matter: Congress should direct the Secretary of Health and Human Services to suspend funding for the Medicare Incentive Payment program until HHS can ensure that funding is specifically targeted to Medicare beneficiaries having difficulty accessing a physician because of low Medicare reimbursement rates for primary care services.

  2. Status: Closed - Not Implemented

    Comments: No action has been taken by Congress to implement this recommendation.

    Matter: To assist underserved populations in accessing federal program resources most appropriate for their needs, and to enable HHS in targeting its resources more specifically to them, Congress should remove legislative requirements for HPSA or MUA designation as a condition of participation in federal programs. Instead, Congress should direct the Secretary of Health and Human Services to incorporate the necessary screening requirements into the conditions of participation of each program that will best match the type of program strategy with the type of access barrier existing for specific underserved populations.


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