Indian Health Service:

Funding Based on Historical Patterns, Not Need

HRD-91-5: Published: Feb 21, 1991. Publicly Released: Mar 1, 1991.

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Janet L. Shikles
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Pursuant to a congressional request, GAO obtained information on: (1) Indian Health Service (IHS) funding distribution methods and the funds allocated for fiscal year (FY) 1980 through FY 1990; (2) per-capita funding for the Oklahoma IHS area; and (3) the effect of IHS funding constraints on health services delivery in Oklahoma, with special attention to the Contract Health Services (CHS) program.

GAO found that: (1) IHS distributed its funding among its 12 service delivery areas based primarily on previous-year funding and rarely used needs-based methods; (2) total IHS funding increased from approximately $517 million in FY 1980 to about $1 billion in FY 1990, and Oklahoma's funding increased from $59.9 million to $131 million during that period; (3) increased needs-based funding for Oklahoma failed to increase its overall funding share; (4) per-capita funding for Oklahoma Indians was relatively low due to limited needs-based funding and the growing number of eligible Indians in the area; and (5) IHS service delivery was strained in Oklahoma due to substantial increases in demand for outpatient services and rationing of the CHS program.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: Relevant committees decided not to alter the allocation formula during consideration of reauthorization of the Indian Health Service Act.

    Matter: If Congress wants IHS to redistribute funding among the areas, it should consider requiring IHS to distribute its funds based on different methods, for example, methods that give greater weight to measures of need.


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