Indian Health Service Not Yet Distributing Funds Equitably Among Tribes

HRD-82-54: Published: Jul 2, 1982. Publicly Released: Jul 2, 1982.

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GAO reviewed the Indian Health Service's (IHS) distribution of its fiscal year 1981 equity health care fund.

Not all eligible Indians have received an equitable share of IHS funds or services. IHS has distributed an equity health care fund to tribes using a needs-based ranking system that incorporates standards and criteria to estimate staffing or contract care dollars required to provide a range of health services. California Indians received about 74 percent of the fiscal year 1981 equity fund. IHS plans to continue the equity fund until 1984 to raise the level of services provided to those tribes with the greatest need. However, because of weaknesses in the needs-based ranking system, IHS cannot be sure that it distributed its equity fund moneys to the neediest tribes in fiscal year 1981. GAO noted that IHS: (1) used inconsistent and unreliable data to develop tribal health care requirements; (2) understated alternative resources available to tribes to supplement IHS-funded health services; and (3) excluded from its ranking system two multimillion-dollar programs, distorting the tribal rankings. IHS needs to expand its efforts to correct these weaknesses. For the bulk of its appropriations, IHS continues to rely on its policy of funding programs based on the previous year's funding level. This policy has caused many of the funding inequities. To distribute funds equitably among tribes, IHS needs to use a more rational system for allocating all of its health services appropriations. The equity fund's needs-based ranking system could provide a basis for distributing IHS health services appropriations.

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 require the Director of IHS to: (1) develop more reliable data for estimating health care requirements and available resources, including accurate and complete contract health care estimates and uniformly developed and verifiable workload data; (2) develop a mechanism for identifying and reporting alternate resources which offset health care requirements; and (3) include community health representatives and emergency medical services programs in the comparison of tribes' health care services.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Not Implemented

    Comments: HHS disagreed with this recommendation. This report was written, as directed by Senate Report 96-985, September 23, 1980. In the absence of any additional congressional requests there is apparently no further interest in pushing this recommendation. Additionally, the Equity Health Care Fund expired at the end of fiscal year 1984.

    Recommendation: The Secretary of Health and Human Services should require the Director of IHS to develop and implement a more equitable funding allocation system by the end of fiscal year 1984, when the equity fund is expected to be discontinued. Specifically, the Director should be required to reduce and eventually abandon reliance on program continuity and, in its place, use standards and criteria that will distribute IHS funds equitably.

    Agency Affected: Department of Health and Human Services


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