Management of and Results Obtained From the Health Care Financing Administration's Demonstration, Experiment, and Related Evaluation Activities

Comments were provided on the evaluation by GAO of the Department of Health, Education, and Welfare's Health Care Financing Administration (HCFA). In 1977, HCFA was established and given responsibility for administering the Medicare and Medicaid programs. This purpose was to be carried out through a wide variety of scientific investigations into the causes of rising health care costs and into methodologies which show potential for decreasing costs without adversely affecting the quality of care. In reviewing HCFA, GAO found that: (1) reports to Congress have not been submitted at the dates specified by law; (2) when reports were submitted, they did not meet the specifications contained in the law and/or related committee reports; (3) more recent mandated demonstrations have not been undertaken due to a shortage of staff or money; (4) demonstrations and experiments or the related evaluations were sometimes completed after Congress or its committees had already deliberated and acted on the issues involved; (5) the HCFA Office of Research, Demonstrations, and Statistics (ORDS) could not readily determine the specific outcomes or impacts of its demonstrations and experiments activities (D&E); (6) the processes for carrying out the ORDS D&E activities often involved long periods of time; and (7) congressionally mandated D&E activities have not been given priority over nonmandated ORDS research programs. Moreover, GAO believes that to effect improvement within HCFA: (1) there is a need for more involvement of policymakers in the planning process; (2) planning should include identification of the knowledge needed; (3) there is a need to arrange priorities to assure that the expectations of congressional mandates are timely met; (4) ORDS should identify, obtain, and retain raw data from D&E activities where the data are likely to prove useful in future research, and should verify the data to assure the accuracy and acceptability of project results; (5) there is a need for a control and tracking system which identifies the interim D&E results of ongoing projects by subject matter; (6) ORDS should take a formal position on the final results reported from each project as to their validity, policy implications, and usage; (7) there should be a systematic assessment of the utilization of the results of D&E activities and the outcomes of such utilization; and (8) there is a need for management to more explicitly inform professional staffs of what is expected of them.