Health Care Shortage Areas

Many Americans live in places where barriers exist to obtaining basic health care. These areas range from isolated rural locations to inner-city neighborhoods. In fiscal year 1994, the federal government spent about $1 billion on programs to overcome access problems in such locations. To be effective, these programs need a sound method of identifying the type of access problems that exist and focusing services on the people who need them. The Department of Health and Human Services uses two main system to identify such locales. One designates Health Professional Shortage Areas, the other Medically Underserved Areas. More than half of all U.S. counties fall into these two categories. GAO reviewed the two systems to determined (1) how well they identify areas with primary care shortages, (2) how well they help target federal funding to benefit those who are underserved, and (3) whether they are likely to be improved under proposals to combine them.

GAO found that: (1) the two HHS systems do not reliably identify areas with primary care shortages or help target federal resources to the underserved; (2) the systems have widespread data and methodology problems which severely limit their ability to pinpoint needy areas; (3) both systems tend to overstate the need for additional primary care providers because they do not consider all of the categories of providers already in place; (4) the Health Professional Shortage Area System (HPSA) does not consider the extent to which available resources are being used; (5) the Medically Underserved Area System (MUA) is limited in its ability to identify underserved areas and populations; (6) neither system identifies the specific subpopulations that have difficulty obtaining medical care; (7) while the systems can sometimes accurately identify needy areas, they do not provide the necessary data to determine which programs are best suited to those areas; (8) the proposed consolidation and streamlining of the systems is not likely to solve system problems, since the underlying causes of the problems have not been addressed; (9) it may be more cost-effective to modify individual programs and application processes to identify where needs exist and the appropriate program to meet those needs and to target resources better; and (10) HHS officials believe that they need to maintain a national shortage designation system to monitor primary care access, but HHS has another initiative under way that could serve those purposes.

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.

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