Health Service Program Needs Assessments Found Inadequate

HRD-81-63: Published: Jun 15, 1981. Publicly Released: Jun 15, 1981.

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The Department of Health and Human Services (HHS) has initiated and supported grant programs aimed at increasing primary health care capacity in medically underserved areas (MUA), preventing and treating substance abuse, and providing services to deal with mental illness. Each of these programs requires that an assessment of the need for the proposed services be made. GAO reviewed the needs assessment processes used to justify funding grantees under the rural and urban health initiatives and several other health programs administered by HHS.

The MUA designation criteria HHS used to establish grantee funding eligibility were developed as a rough indicator of the adequacy of medical service in an area and had several weaknesses. Despite these weaknesses, HHS applied the criteria, without change, as the specific measure of medical underservice for rural and urban community health center programs. The review of needs assessment preparation and evaluation shows that: (1) HHS had provided little guidance on how grant applicants should meet the legislative requirement of performing a needs assessment; (2) many grantees have approached fulfilling the requirement in a manner which seems to minimize the apparent need for a health center without adequate regard for the validity of data used and opposing views that raise fundamental questions about need; and (3) HHS grant application reviews are inadequate, and HHS seems to rely heavily on the MUA designation of the proposed service area, which was intended only to be a rough indicator of the adequacy of medical service in an area. GAO recognizes that many areas of the Nation have problems with the availability of and access to health services. However, in the opinion of GAO, the need determination mechanisms for the community health center programs, as presently structured and operated, provide little assurance that MUA's have been appropriately identified and are not an adequate basis for establishing specific urban and rural health centers.

Matter for Congressional Consideration

  1. Status:

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

    Matter: Congress should incorporate a requirement in the community health center legislation that grant applicants be required to perform a demand analysis in conjunction with a needs assessment.

Recommendations for Executive Action

  1. Status:

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

    Recommendation: The Secretary of HHS should establish mechanisms for verifying the information contained in all grant applications.

    Agency Affected: Department of Health and Human Services

  2. Status:

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

    Recommendation: The Secretary of HHS should clearly define what constitutes need or eligibility for purposes of Federal funding.

    Agency Affected: Department of Health and Human Services

  3. Status:

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

    Recommendation: The Secretary of HHS should develop a definition of "medical underservice" specifically for the rural and urban community health center program.

    Agency Affected: Department of Health and Human Services

  4. Status:

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

    Recommendation: The Secretary of HHS should give HHS reviewers direction on how need and demand information should be used in the grant review process.

    Agency Affected: Department of Health and Human Services

  5. Status:

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

    Recommendation: The Secretary of HHS should establish a specific timetable for updating future MUA lists that would consider current data as they become available.

    Agency Affected: Department of Health and Human Services

  6. Status:

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

    Recommendation: The Secretary of HHS should reevaluate the eligibility of existing grantees in light of the these recommendations and phase out those that cannot meet the revised requirements.

    Agency Affected: Department of Health and Human Services

  7. Status:

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

    Recommendation: The Secretary of HHS should revise the grant application review and approval procedures to ensure that future applications comply with all legislative and program requirements.

    Agency Affected: Department of Health and Human Services

  8. Status:

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

    Recommendation: The Secretary of HHS should update the MUA list and, to the extent practical, consider the other weaknesses discussed in this report relating to the MUA criteria, recognizing they should be used only as a rough indicator of the adequacy of medical service in an area.

    Agency Affected: Department of Health and Human Services

  9. Status:

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

    Recommendation: The Secretary of HHS should develop rough need indicators, similar to the MUA concept, which would serve as screens to identify geographic areas that would be candidates for Federal funding under the various health service programs.

    Agency Affected: Department of Health and Human Services

  10. Status:

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

    Recommendation: The Secretary of HHS should develop and provide to prospective grantees guidance on how to perform and what should be included in needs and demand assessments for the program. As a minimum, the guidance should require that (1) rational service areas be established; (2) all health care services in the proposed target area and in contiguous areas be addressed in terms of availability and accessibility; (3) asserted health care problems be documented, and (4) opposition views be addressed in grant applications.

    Agency Affected: Department of Health and Human Services

  11. Status:

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

    Recommendation: The Secretary of HHS should develop needs assessment guidance for the use of grant applicants that would address the need for services as well as a realistic analysis of the potential demand for services. As was recommended for the community health center program, such guidance should require that (1) rational service areas be established, (2) health care services in the proposed target areas and in contiguous areas be addressed in terms of availability and accessibility, (3) asserted health care problems be documented, and (4) opposition views be addressed in grant applications.

    Agency Affected: Department of Health and Human Services

  12. Status:

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

    Recommendation: The Secretary of HHS should use the MUA designation process only as a rough indicator of the adequacy of medical service for determining areas of the Nation warranting more detailed assessment of need for purposes of Federal funding.

    Agency Affected: Department of Health and Human Services

 

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