Indian Health Service Not Yet Distributing Funds Equitably Among Tribes

Gao ID: HRD-82-54 July 2, 1982

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

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Franklin A. Curtis Team: General Accounting Office: Human Resources Division Phone: (202) 275-5451


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