Health Resources and Services Administration
Many Underserved Areas Lack a Health Center Site, and Data Are Needed on Service Provision at Sites Gao ID: GAO-09-667T April 30, 2009Health centers funded through grants under the Health Center Program--managed by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS)--provide comprehensive primary care services for the medically underserved. The statement GAO is issuing today summarizes an August 2008 report, Health Resources and Services Administration: Many Underserved Areas Lack a Health Center Site, and the Health Center Program Needs More Oversight (GAO-08-723). In that report, GAO examined to what extent medically underserved areas (MUA) lacked health center sites in 2006 and 2007. To do this, GAO obtained and analyzed HRSA data and grant application
In its August 2008 report, which is summarized in this statement, GAO found the following: (1) Grant awards for new health center sites in 2007 reduced the overall percentage of MUAs lacking a health center site from 47 percent in 2006 to 43 percent in 2007. (2) There was wide geographic variation in the percentage of MUAs that lacked a health center site in both years. (3) Most of the 2007 nationwide decline in the number of MUAs that lacked a health center site occurred in the South census region, in large part because half of all awards made in 2007 for new health center sites were granted to the South census region. (4) HRSA lacked readily available data on the services provided at individual health center sites. GAO concluded that from 2006 to 2007, HRSA's grant awards to open new health center sites reduced the number of MUAs that lacked a site by about 7 percent. However, in 2007, 43 percent of MUAs continued to lack a health center site, and the grants for new sites awarded that year had little impact on the wide variation among census regions and states in the percentage of MUAs lacking a health center site. GAO reported that HRSA's grants to open new health center sites increased access to primary health care services for underserved populations in needy areas, including MUAs. However, HRSA's ability to place new health center sites in locations where they are most needed was limited because HRSA does not collect and maintain readily available information on the services provided at individual health center sites. Because each health center site may not provide the full range of comprehensive primary care services, having readily available information on the services provided at each site is important for HRSA's effective consideration of need when distributing federal resources for new health center sites.
GAO-09-667T, Health Resources and Services Administration: Many Underserved Areas Lack a Health Center Site, and Data Are Needed on Service Provision at Sites
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Testimony:
Before the Committee on Health, Education, Labor, and Pensions, U.S.
Senate:
United States Government Accountability Office:
GAO:
For Release on Delivery:
Expected at 10:00 a.m. EDT:
Thursday, April 30, 2009:
Health Resources and Services Administration:
Many Underserved Areas Lack a Health Center Site, and Data Are Needed
on Service Provision at Sites:
Statement of Cynthia A. Bascetta:
Director, Health Care:
GAO-09-667T:
GAO Highlights:
Highlights of GAO-09-667T, a testimony before the Committee on Health,
Education, Labor, and Pensions, U.S. Senate.
Why GAO Did This Study:
Health centers funded through grants under the Health Center Program”
managed by the Health Resources and Services Administration (HRSA) of
the U.S. Department of Health and Human Services (HHS)”provide
comprehensive primary care services for the medically underserved. The
statement GAO is issuing today summarizes an August 2008 report, Health
Resources and Services Administration: Many Underserved Areas Lack a
Health Center Site, and the Health Center Program Needs More Oversight
(GAO-08-723). In that report, GAO examined to what extent medically
underserved areas (MUA) lacked health center sites in 2006 and 2007. To
do this, GAO obtained and analyzed HRSA data and grant applications and
interviewed HRSA officials.
What GAO Found:
In its August 2008 report, which is summarized in this statement, GAO
found the following:
* Grant awards for new health center sites in 2007 reduced the overall
percentage of MUAs lacking a health center site from 47 percent in 2006
to 43 percent in 2007.
* There was wide geographic variation in the percentage of MUAs that
lacked a health center site in both years. (See figure.)
* Most of the 2007 nationwide decline in the number of MUAs that lacked
a health center site occurred in the South census region, in large part
because half of all awards made in 2007 for new health center sites
were granted to the South census region.
* HRSA lacked readily available data on the services provided at
individual health center sites.
Figure: Percentages of MUAs that Lacked a Health Center Site, by Census
Region, 2006 and 2007:
[Refer to PDF for image: map of the United States]
Census Region: Northeast;
MUAs that lacked a health center site, 2006: 39%;
MUAs that lacked a health center site, 2007: 37%.
Census Region: Midwest;
MUAs that lacked a health center site, 2006: 62%;
MUAs that lacked a health center site, 2007: 60%.
Census Region: South;
MUAs that lacked a health center site, 2006: 45%;
MUAs that lacked a health center site, 2007: 40%.
Census Region: West;
MUAs that lacked a health center site, 2006: 32%;
MUAs that lacked a health center site, 2007: 31%.
Source: Copyright © Corel Corp. All rights reserved (map); GAO analysis
of HRSA and U.S. Census Bureau data.
[End of figure]
GAO concluded that from 2006 to 2007, HRSA's grant awards to open new
health center sites reduced the number of MUAs that lacked a site by
about 7 percent. However, in 2007, 43 percent of MUAs continued to lack
a health center site, and the grants for new sites awarded that year
had little impact on the wide variation among census regions and states
in the percentage of MUAs lacking a health center site. GAO reported
that HRSA‘s grants to open new health center sites increased access to
primary health care services for underserved populations in needy
areas, including MUAs. However, HRSA‘s ability to place new health
center sites in locations where they are most needed was limited
because HRSA does not collect and maintain readily available
information on the services provided at individual health center sites.
Because each health center site may not provide the full range of
comprehensive primary care services, having readily available
information on the services provided at each site is important for HRSA‘
s effective consideration of need when distributing federal resources
for new health center sites.
What GAO Recommends:
In its report, GAO recommended, among other things, that HRSA collect
site-specific data on services provided at each health center site. HHS
commented that collecting these data would be helpful for many
purposes, but would create a burden on grantees and add expense to the
program. While GAO acknowledges that effort and cost are involved in
program management activities, this information is essential for
effective HRSA decision making on placement of new health center sites
and for evaluating potential service area overlap in MUAs.
View [hyperlink, http://www.gao.gov/products/GAO-09-667T] or key
components. For more information, contact Cynthia A. Bascetta at (202)
512-7114 or bascettac@gao.gov.
[End of section]
Mr. Chairman and Members of the Committee:
I am pleased to be here today to discuss our work on the extent to
which health centers in the federal Health Center Program are located
in areas having a shortage of health care services. Health centers
provide comprehensive primary health care services--preventive,
diagnostic, treatment, and emergency services, as well as referrals to
specialty care--to federally designated medically underserved
populations (MUP), or those individuals residing in federally
designated medically underserved areas (MUA).[Footnote 1] The people
served by health centers include Medicaid beneficiaries, the uninsured,
and others who may have difficulty obtaining access to health care. To
fulfill the Health Center Program's mission of increasing access to
primary health care services for the medically underserved, the Health
Resources and Services Administration (HRSA)--the agency within the
U.S. Department of Health and Human Services (HHS) that administers the
Health Center Program--provides grants to health centers.[Footnote 2] A
health center grantee may provide services at one or more delivery
sites--known as health center sites. HRSA does not require all health
center sites to provide the full range of comprehensive primary care
services; some health center sites may provide only limited services,
such as dental or mental health services. In 2006, approximately 1,000
health center grantees operated more than 6,000 health center sites
that served more than 15 million people. Additional people may need to
rely on health centers for their care during the current economic
period.
Beginning in fiscal year 2002, HRSA significantly expanded the Health
Center Program under a 5-year effort--the President's Health Centers
Initiative--to increase access to comprehensive primary care services
for underserved populations, including those in MUAs. Under the
initiative, HRSA set a goal of awarding 630 grants to open new health
center sites--such grants are known as new access point grants--and 570
grants to expand services at existing health center sites by the end of
fiscal year 2006. New access point grants fund one or more new health
center sites operated by either new or existing health center grantees.
In July 2005, we reported challenges HRSA encountered during this
expansion of the Health Center Program.[Footnote 3] In particular, we
found that HRSA's process for awarding new access point grants might
not sufficiently target communities with the greatest need for
services, although we concluded that changes HRSA had made to its grant
award process could help the agency appropriately consider community
need when distributing federal resources. We also reported that HRSA
lacked reliable information on the number and location of the sites
where health centers provide care, and we recommended, among other
things, that HRSA collect this information. In response to our
recommendation, HRSA took steps to improve its data collection efforts
in 2006 to more reliably account for the number and location of health
center sites funded under the Health Center Program.
By the end of fiscal year 2007, HRSA had achieved its grant goals under
the original President's Health Centers Initiative and launched a
second nationwide effort, the High Poverty County Presidential
Initiative. In fiscal year 2007, HRSA held two new access point
competitions, one focused on opening new health center sites in up to
200 HRSA-selected counties that lacked a health center site--part of
the High Poverty County Presidential Initiative--and one that was an
open competition.[Footnote 4]
My statement today is based largely on our August 2008 report entitled
Health Resources and Services Administration: Many Underserved Areas
Lack a Health Center Site, and the Health Center Program Needs More
Oversight.[Footnote 5] In the August 2008 report, we examined, among
other things, (1) for 2006, the extent to which MUAs lacked health
center sites and the services provided by individual sites in MUAs, and
(2) how new access point grants awarded in 2007 changed the extent to
which MUAs lacked health center sites.
In carrying out the work for our August 2008 report examining the
extent to which MUAs lacked health center sites and the services
provided by individual sites in 2006, we interviewed HRSA officials and
obtained health center site data from HRSA's uniform data system (UDS),
and then compared the location of health center sites with the location
of MUAs by census region and state.[Footnote 6] We limited our analysis
to health center sites operated by grantees that received community
health center funding--the type of funding that requires sites to
provide services to all residents of the service area regardless of
their ability to pay.[Footnote 7] In addition, because HRSA takes into
account the location of federally qualified health center look-alike
sites--facilities that operate like health center sites but do not
receive HRSA funding[Footnote 8]--when deciding where to award new
access point grants, we obtained from HRSA the location of health
center look-alike sites in 2006 and compared them with the location of
MUAs. To examine how new access point grants awarded in 2007 changed
the extent to which MUAs lacked health center sites nationwide, we
obtained data from HRSA and compared the location of proposed and
funded new health center sites in 2007 with the location of MUAs in
2007.[Footnote 9] As with the 2006 analysis, we limited our review to
health center sites operated by grantees that requested community
health center funding, and we obtained from HRSA the location of health
center look-alike sites in 2007 and compared them to the location of
MUAs in 2007. We discussed our data sources with knowledgeable agency
officials and performed data reliability checks, such as examining the
data for missing values and obvious errors, to test the internal
consistency and reliability of the data. After taking these steps, we
determined that the data were sufficiently reliable for our purposes.
We conducted the performance audit for the August 2008 report from
April 2007 through July 2008, in accordance with generally accepted
government auditing standards. Those standards require that we plan and
perform the audit to obtain sufficient, appropriate evidence to provide
a reasonable basis for our findings and conclusions based on our audit
objectives. We believe that the evidence obtained provides a reasonable
basis for our findings and conclusions based on our audit objectives. A
detailed explanation of our methodology is included in our August 2008
report.
In brief, we found that grant awards for new health center sites in
2007 reduced the overall percentage of MUAs lacking a health center
site from 47 percent in 2006 to 43 percent in 2007. In addition, we
found wide geographic variation in the percentage of MUAs that lacked a
health center site in both years. We reported that, for 2006, we could
not determine the types of services provided by individual health
center sites in MUAs because HRSA does not collect and maintain data on
the types of services provided at each site. Because HRSA lacks readily
available data on the types of services provided at individual sites,
the extent to which individuals in MUAs have access to the full range
of comprehensive primary care services is unknown. In reporting on
geographic variation, we found that, for 2007, the West and Midwest
census regions continued to show the lowest and highest percentages,
respectively, of MUAs that lacked health center sites. In addition,
three of the four census regions showed a 1 or 2 percentage point
decrease since 2006 in MUAs that lacked a health center site, while the
South census region showed a 5 percentage point decrease. The minimal
impact of the 2007 awards on geographic variation overall was due, in
large part, to the fact that the majority of the decline in MUAs that
lacked a health center site was concentrated in the South census
region, which received the largest proportion of the awards made in
2007. To help improve the agency's ability to measure access to
comprehensive primary care services in MUAs, we recommended that HRSA
collect and maintain readily available data on the types of services
provided at each health center site. In commenting on a draft of our
report, HHS raised concerns regarding this recommendation. HHS
acknowledged that site-specific information would be helpful for many
purposes, but said collecting this information would place a
significant burden on grantees and raise the program's administrative
expenses. While we acknowledge that effort and cost are involved in
program management activities, we believe that having site-specific
information on services provided is essential to help HRSA better
measure access to comprehensive primary health care services in MUAs
when considering the placement of new health center sites and to
facilitate the agency's ability to evaluate service area overlap in
MUAs.
Almost Half of MUAs Lacked a Health Center Site in 2006, and Types of
Services Provided by Each Site Could Not Be Determined:
In August 2008, we reported that almost half of MUAs nationwide--47
percent, or 1,600 of 3,421--lacked a health center site in 2006,
[Footnote 10] and there was wide variation among the four census
regions and across states in the percentage of MUAs that lacked health
center sites. (See figure 1.) The Midwest census region had the most
MUAs that lacked a health center site (62 percent), while the West
census region had the fewest MUAs that lacked a health center site (32
percent). More than three-quarters of the MUAs in 4 states--Nebraska
(91 percent), Iowa (82 percent), Minnesota (77 percent), and Montana
(77 percent)--lacked a health center site. (See appendix I for more
detail on the percentage of MUAs in each state and the U.S. territories
that lacked a health center site in 2006.) In 2006, among all MUAs, 32
percent contained more than one health center site; among MUAs with at
least one health center site, 60 percent contained multiple health
center sites, with about half of those containing two or three sites.
Almost half of all MUAs in the West census region contained more than
one health center site, while less than one-quarter of MUAs in the
Midwest contained more than one site. The states with three-quarters or
more of their MUAs containing more than one health center site were
Alaska, Connecticut, the District of Columbia, Hawaii, New Hampshire,
and Rhode Island. In contrast, Nebraska, Iowa, and North Dakota were
the states where less than 10 percent of MUAs contained more than one
site.
Figure 1: Percentage of MUAs That Lacked a Health Center Site, by
Census Region and State, 2006:
[Refer to PDF for image: map of the United States]
Northeast Region (Regional average: 39%):
State: Connecticut;
Number of MUAs in the state: 17;
Percentage of MUAs that lacked a health center site: 1-25%.
State: Maine;
Number of MUAs in the state: 30;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Massachusetts;
Number of MUAs in the state: 40;
Percentage of MUAs that lacked a health center site: 1-25%.
State: New Hampshire;
Number of MUAs in the state: 5;
Percentage of MUAs that lacked a health center site: 1-25%.
State: New Jersey;
Number of MUAs in the state: 28;
Percentage of MUAs that lacked a health center site: 1-25%.
State: New York;
Number of MUAs in the state: 115;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Pennsylvania;
Number of MUAs in the state: 137;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Rhode Island;
Number of MUAs in the state: 7;
Percentage of MUAs that lacked a health center site: 0.
State: Vermont;
Number of MUAs in the state: 16;
Percentage of MUAs that lacked a health center site: 51-75%.
South Region (Regional average: 45%):
State: Alabama;
Number of MUAs in the state: 96;
Percentage of MUAs that lacked a health center site: 1-25%.
State: Arkansas;
Number of MUAs in the state: 92;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Delaware;
Number of MUAs in the state: 4;
Percentage of MUAs that lacked a health center site: 0.
State: District of Columbia;
Number of MUAs in the state: 9;
Percentage of MUAs that lacked a health center site: 0.
State: Florida;
Number of MUAs in the state: 35;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Georgia;
Number of MUAs in the state: 147;
Percentage of MUAs that lacked a health center site: 51-75%.
State: Kentucky;
Number of MUAs in the state: 78;
Percentage of MUAs that lacked a health center site: 51-75%.
State: Louisiana;
Number of MUAs in the state: 73;
Percentage of MUAs that lacked a health center site: 51-75%.
State: Maryland;
Number of MUAs in the state: 38;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Mississippi;
Number of MUAs in the state: 91;
Percentage of MUAs that lacked a health center site: 1-25%.
State: North Carolina;
Number of MUAs in the state: 107;
Percentage of MUAs that lacked a health center site: 51-75%.
State: Oklahoma;
Number of MUAs in the state: 65;
Percentage of MUAs that lacked a health center site: 51-75%.
State: South Carolina;
Number of MUAs in the state: 68;
Percentage of MUAs that lacked a health center site: 1-25%.
State: Tennessee;
Number of MUAs in the state: 101;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Texas;
Number of MUAs in the state: 282;
Percentage of MUAs that lacked a health center site: 51-75%.
State: Virginia;
Number of MUAs in the state: 92;
Percentage of MUAs that lacked a health center site: 26-50%.
State: West Virginia;
Number of MUAs in the state: 57;
Percentage of MUAs that lacked a health center site: 1-25%.
Midwest Region (Regional average: 39%):
State: Illinois;
Number of MUAs in the state: 146;
Percentage of MUAs that lacked a health center site: 51-75%.
State: Indiana;
Number of MUAs in the state: 61;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Iowa;
Number of MUAs in the state: 73;
Percentage of MUAs that lacked a health center site: 76-100%.
State: Kansas;
Number of MUAs in the state: 66;
Percentage of MUAs that lacked a health center site: 51-75%.
State: Michigan;
Number of MUAs in the state: 89;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Minnesota;
Number of MUAs in the state: 96;
Percentage of MUAs that lacked a health center site: 76-100%.
State: Missouri;
Number of MUAs in the state: 116;
Percentage of MUAs that lacked a health center site: 51-75%.
State: Nebraska;
Number of MUAs in the state: 82;
Percentage of MUAs that lacked a health center site: 76-100%.
State: North Dakota;
Number of MUAs in the state: 55;
Percentage of MUAs that lacked a health center site: 51-75%.
State: Ohio;
Number of MUAs in the state: 111;
Percentage of MUAs that lacked a health center site: 26-50%.
State: South Dakota;
Number of MUAs in the state: 65;
Percentage of MUAs that lacked a health center site: 51-75%.
State: Wisconsin;
Number of MUAs in the state: 67;
Percentage of MUAs that lacked a health center site: 51-75%.
West Region (Regional average: 32%):
State: Alaska;
Number of MUAs in the state: 17;
Percentage of MUAs that lacked a health center site: 0.
State: Arizona;
Number of MUAs in the state: 33;
Percentage of MUAs that lacked a health center site: 26-50%.
State: California;
Number of MUAs in the state: 165;
Percentage of MUAs that lacked a health center site: 1-25%.
State: Colorado;
Number of MUAs in the state:
Percentage of MUAs that lacked 42; a health center site: 1-25%.
State: Hawaii;
Number of MUAs in the state: 4;
Percentage of MUAs that lacked a health center site: 0.
State: Idaho;
Number of MUAs in the state: 35;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Montana;
Number of MUAs in the state: 44;
Percentage of MUAs that lacked a health center site: 76-100%.
State: Nevada;
Number of MUAs in the state: 8;
Percentage of MUAs that lacked a health center site: 26-50%.
State: New Mexico;
Number of MUAs in the state: 36;
Percentage of MUAs that lacked a health center site: 1-25%.
State: Oregon;
Number of MUAs in the state: 42;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Utah;
Number of MUAs in the state: 17;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Washington;
Number of MUAs in the state: 31;
Percentage of MUAs that lacked a health center site: 26-50%.
State: Wyoming;
Number of MUAs in the state: 11;
Percentage of MUAs that lacked a health center site: 51-75%.
Source: Copyright © Corel Corp. All rights reserved (map); GAO analysis
of HRSA and U.S. Census Bureau data.
Note: U.S. territories are not included in this map.
[End of figure]
We could not determine the types of primary care services provided at
individual health center sites because HRSA did not collect and
maintain readily available data on the types of services provided at
individual sites. While HRSA requests information from applicants in
their grant applications on the services each site provides, in order
for HRSA to access and analyze individual health center site
information on the services provided, HRSA would have to retrieve this
information from the grant applications manually. HRSA separately
collects data through the UDS from each grantee on the types of
services it provides across all of its health center sites, but HRSA
does not collect data on services provided at each site. Although each
grantee with community health center funding is required to provide the
full range of comprehensive primary care services, HRSA does not
require each grantee to provide all services at each health center site
it operates. HRSA officials told us that some sites provide limited
services--such as dental or mental health services. Because HRSA lacks
readily available data on the types of services provided at individual
sites, it cannot determine the extent to which individuals residing in
MUAs have access to the full range of comprehensive primary care
services provided by health center grantees. This lack of basic
information can limit HRSA's ability to assess the full range of
primary care services available in needy areas when considering the
placement of new access points and can also limit the agency's ability
to evaluate service area overlap in MUAs.
2007 Awards Reduced the Number of MUAs That Lacked a Health Center
Site, but Wide Geographic Variation Remained:
In August 2008, we reported that our analysis of new access point
grants awarded in 2007 showed that these awards reduced the number of
MUAs that lacked a health center site by about 7 percent. Specifically,
113 fewer MUAs in 2007--or 1,487 MUAs in all--lacked a health center
site when compared with the 1,600 MUAs that lacked a health center site
in 2006. (See appendix I.) As a result, 43 percent of MUAs nationwide
lacked a health center site in 2007.[Footnote 11] Despite the overall
reduction in the percentage of MUAs nationwide that lacked health
center sites in 2007, regional variation remained. The West and Midwest
census regions continued to show the lowest and highest percentages of
MUAs that lacked health center sites, respectively. (See figure 2.)
Three of the four census regions showed a 1 or 2 percentage point
decrease since 2006 in the percentage of MUAs that lacked a health
center site, while the South census region showed a 5 percentage point
decrease.
Figure 2: Percentage of MUAs That Lacked a Health Center Site, by
Census Region, 2007:
[Refer to PDF for image: map of the United States]
Census Region: Northeast;
MUAs that lacked a health center site, 2007: 37%.
Census Region: Midwest;
MUAs that lacked a health center site, 2007: 60%.
Census Region: South;
MUAs that lacked a health center site, 2007: 40%.
Census Region: West;
MUAs that lacked a health center site, 2007: 31%.
Source: Copyright © Corel Corp. All rights reserved (map); GAO analysis
of HRSA and U.S. Census Bureau data.
[End of figure]
We found that the minimal impact of the 2007 awards on regional
variation was due, in large part, to the fact that more than two-thirds
of the nationwide decline in the number of MUAs that lacked a health
center site--77 out of the 113 MUAs--occurred in the South census
region. In contrast, only 24 of the 113 MUAs were located in the
Midwest census region, even though the Midwest had nearly as many MUAs
that lacked a health center site in 2006 as the South census region.
While the number of MUAs that lacked a health center site declined by
12 percent in the South census region, the other census regions
experienced declines of about 4 percent. The South census region
experienced the greatest decline in the number of MUAs lacking a health
center site in 2007 in large part because it was awarded more new
access point grants that year than any other region. Specifically, half
of all new access point awards made in 2007--from the two separate new
access point competitions--went to applicants from the South census
region. For example, when we examined the High Poverty County new
access point competition, in which 200 counties were targeted by HRSA
for new health center sites, we found that 69 percent of those awards
were granted to applicants from the South census region. The greater
number of awards made to the South census region may be explained by
the fact that nearly two-thirds of the 200 counties targeted were
located in the South census region. When we examined the open new
access point competition, which did not target specific areas, we found
that the South census region also received a greater number of awards
than any other region under that competition. Specifically, the South
census region was granted nearly 40 percent of awards; in contrast, the
Midwest received only 17 percent of awards.
Concluding Observations:
In our August 2008 report, we noted that awarding new access point
grants is central to HRSA's ongoing efforts to increase access to
primary health care services in MUAs. From 2006 to 2007, HRSA's new
access point awards achieved modest success in reducing the percentage
of MUAs that lacked a health center site nationwide. However, in 2007,
43 percent of MUAs continued to lack a health center site, and the new
access point awards made in 2007 had little impact on the wide
variation among census regions and states in the percentage of MUAs
lacking a health center site. The relatively small effect of the 2007
awards on geographic variation may be explained, in part, because the
South census region received a greater number of awards than other
regions, even though the South was not the region with the highest
percentage of MUAs lacking a health center site in 2006.
We reported that HRSA awards new access point grants to open new health
center sites, which increase access to primary health care services for
underserved populations in needy areas, including MUAs. However, HRSA's
ability to target these awards and place new health center sites in
locations where they are most needed is limited because HRSA does not
collect and maintain readily available information on the services
provided at individual health center sites. Having readily available
information on the services provided at each site is important for
HRSA's effective consideration of need when distributing federal
resources for new health center sites, because each health center site
may not provide the full range of comprehensive primary care services.
This information could also help HRSA assess any potential overlap of
services provided by health center sites in MUAs.
Mr. Chairman, this concludes my prepared statement. I would be happy to
answer any questions that you or Members of the Committee may have.
GAO Contacts and Staff Acknowledgments:
For further information about this statement, please contact Cynthia A.
Bascetta at (202) 512-7114 or bascettac@gao.gov. Contact points for our
Offices of Congressional Relations and Public Affairs may be found on
the last page of this statement. Key contributors to this statement
were Helene Toiv, Assistant Director; Stella Chiang; Karen Doran; and
Karen Howard.
[End of section]
Appendix I: Number and Percentage of Medically Underserved Areas (MUA)
Lacking a Health Center Site, 2006 and 2007:
Midwest census region:
Total number of MUAs: 2006: 1,027;
Total number of MUAs: 2007: 1,029;
Number of MUAs lacking a health center site: 2006: 641;
Number of MUAs lacking a health center site: 2007: 617;
Percentage of MUAs lacking a health center site: 2006: 62;
Percentage of MUAs lacking a health center site: 2007: 60.
Midwest census region: Illinois;
Total number of MUAs: 2006: 146;
Total number of MUAs: 2007: 143;
Number of MUAs lacking a health center site: 2006: 71;
Number of MUAs lacking a health center site: 2007: 63;
Percentage of MUAs lacking a health center site: 2006: 49;
Percentage of MUAs lacking a health center site: 2007: 44.
Midwest census region: Indiana;
Total number of MUAs: 2006: 61;
Total number of MUAs: 2007: 61;
Number of MUAs lacking a health center site: 2006: 35;
Number of MUAs lacking a health center site: 2007: 34;
Percentage of MUAs lacking a health center site: 2006: 57;
Percentage of MUAs lacking a health center site: 2007: 56.
Midwest census region: Iowa;
Total number of MUAs: 2006: 73;
Total number of MUAs: 2007: 73;
Number of MUAs lacking a health center site: 2006: 60;
Number of MUAs lacking a health center site: 2007: 56;
Percentage of MUAs lacking a health center site: 2006: 82;
Percentage of MUAs lacking a health center site: 2007: 77.
Midwest census region: Kansas;
Total number of MUAs: 2006: 66;
Total number of MUAs: 2007: 71;
Number of MUAs lacking a health center site: 2006: 49;
Number of MUAs lacking a health center site: 2007: 52;
Percentage of MUAs lacking a health center site: 2006: 74;
Percentage of MUAs lacking a health center site: 2007: 73.
Midwest census region: Michigan;
Total number of MUAs: 2006: 89;
Total number of MUAs: 2007: 89;
Number of MUAs lacking a health center site: 2006: 44;
Number of MUAs lacking a health center site: 2007: 43;
Percentage of MUAs lacking a health center site: 2006: 49;
Percentage of MUAs lacking a health center site: 2007: 48.
Midwest census region: Minnesota;
Total number of MUAs: 2006: 96;
Total number of MUAs: 2007: 97;
Number of MUAs lacking a health center site: 2006: 74;
Number of MUAs lacking a health center site: 2007: 75;
Percentage of MUAs lacking a health center site: 2006: 77;
Percentage of MUAs lacking a health center site: 2007: 77.
Midwest census region: Missouri;
Total number of MUAs: 2006: 116;
Total number of MUAs: 2007: 116;
Number of MUAs lacking a health center site: 2006: 62;
Number of MUAs lacking a health center site: 2007: 58;
Percentage of MUAs lacking a health center site: 2006: 53;
Percentage of MUAs lacking a health center site: 2007: 50.
Midwest census region: Nebraska;
Total number of MUAs: 2006: 82;
Total number of MUAs: 2007: 82;
Number of MUAs lacking a health center site: 2006: 75;
Number of MUAs lacking a health center site: 2007: 73;
Percentage of MUAs lacking a health center site: 2006: 91;
Percentage of MUAs lacking a health center site: 2007: 89.
Midwest census region: North Dakota;
Total number of MUAs: 2006: 55;
Total number of MUAs: 2007: 55;
Number of MUAs lacking a health center site: 2006: 40;
Number of MUAs lacking a health center site: 2007: 39;
Percentage of MUAs lacking a health center site: 2006: 73;
Percentage of MUAs lacking a health center site: 2007: 71.
Midwest census region: Ohio;
Total number of MUAs: 2006: 111;
Total number of MUAs: 2007: 110;
Number of MUAs lacking a health center site: 2006: 48;
Number of MUAs lacking a health center site: 2007: 42;
Percentage of MUAs lacking a health center site: 2006: 43;
Percentage of MUAs lacking a health center site: 2007: 38.
Midwest census region: South Dakota;
Total number of MUAs: 2006: 65;
Total number of MUAs: 2007: 65;
Number of MUAs lacking a health center site: 2006: 40;
Number of MUAs lacking a health center site: 2007: 40;
Percentage of MUAs lacking a health center site: 2006: 62;
Percentage of MUAs lacking a health center site: 2007: 62.
Midwest census region: Wisconsin;
Total number of MUAs: 2006: 67;
Total number of MUAs: 2007: 67;
Number of MUAs lacking a health center site: 2006: 43;
Number of MUAs lacking a health center site: 2007: 42;
Percentage of MUAs lacking a health center site: 2006: 64;
Percentage of MUAs lacking a health center site: 2007: 63.
Northeast census region:
Total number of MUAs: 2006: 395;
Total number of MUAs: 2007: 400;
Number of MUAs lacking a health center site: 2006: 153;
Number of MUAs lacking a health center site: 2007: 147;
Percentage of MUAs lacking a health center site: 2006: 39;
Percentage of MUAs lacking a health center site: 2007: 37.
Northeast census region: Connecticut;
Total number of MUAs: 2006: 17;
Total number of MUAs: 2007: 17;
Number of MUAs lacking a health center site: 2006: 1;
Number of MUAs lacking a health center site: 2007: 1;
Percentage of MUAs lacking a health center site: 2006: 6;
Percentage of MUAs lacking a health center site: 2007: 6.
Northeast census region: Maine;
Total number of MUAs: 2006: 30;
Total number of MUAs: 2007: 32;
Number of MUAs lacking a health center site: 2006: 10;
Number of MUAs lacking a health center site: 2007: 11;
Percentage of MUAs lacking a health center site: 2006: 33;
Percentage of MUAs lacking a health center site: 2007: 34.
Northeast census region: Massachusetts;
Total number of MUAs: 2006: 40;
Total number of MUAs: 2007: 40;
Number of MUAs lacking a health center site: 2006: 10;
Number of MUAs lacking a health center site: 2007: 9;
Percentage of MUAs lacking a health center site: 2006: 25;
Percentage of MUAs lacking a health center site: 2007: 23.
Northeast census region: New Hampshire;
Total number of MUAs: 2006: 5;
Total number of MUAs: 2007: 5;
Number of MUAs lacking a health center site: 2006: 1;
Number of MUAs lacking a health center site: 2007: 1;
Percentage of MUAs lacking a health center site: 2006: 20;
Percentage of MUAs lacking a health center site: 2007: 20.
Northeast census region: New Jersey;
Total number of MUAs: 2006: 28;
Total number of MUAs: 2007: 28;
Number of MUAs lacking a health center site: 2006: 1;
Number of MUAs lacking a health center site: 2007: 1;
Percentage of MUAs lacking a health center site: 2006: 4;
Percentage of MUAs lacking a health center site: 2007: 4.
Northeast census region: New York;
Total number of MUAs: 2006: 115;
Total number of MUAs: 2007: 116;
Number of MUAs lacking a health center site: 2006: 56;
Number of MUAs lacking a health center site: 2007: 53;
Percentage of MUAs lacking a health center site: 2006: 49;
Percentage of MUAs lacking a health center site: 2007: 46.
Northeast census region: Pennsylvania;
Total number of MUAs: 2006: 137;
Total number of MUAs: 2007: 139;
Number of MUAs lacking a health center site: 2006: 63;
Number of MUAs lacking a health center site: 2007: 61;
Percentage of MUAs lacking a health center site: 2006: 46;
Percentage of MUAs lacking a health center site: 2007: 44.
Northeast census region: Rhode Island;
Total number of MUAs: 2006: 7;
Total number of MUAs: 2007: 7;
Number of MUAs lacking a health center site: 2006: 0;
Number of MUAs lacking a health center site: 2007: 0;
Percentage of MUAs lacking a health center site: 2006: 0;
Percentage of MUAs lacking a health center site: 2007: 0.
Northeast census region: Vermont;
Total number of MUAs: 2006: 16;
Total number of MUAs: 2007: 16;
Number of MUAs lacking a health center site: 2006: 11;
Number of MUAs lacking a health center site: 2007: 10;
Percentage of MUAs lacking a health center site: 2006: 69;
Percentage of MUAs lacking a health center site: 2007: 63.
South census region:
Total number of MUAs: 2006: 1,435;
Total number of MUAs: 2007: 1,441;
Number of MUAs lacking a health center site: 2006: 651;
Number of MUAs lacking a health center site: 2007: 574;
Percentage of MUAs lacking a health center site: 2006: 45;
Percentage of MUAs lacking a health center site: 2007: 40.
South census region: Alabama;
Total number of MUAs: 2006: 96;
Total number of MUAs: 2007: 96;
Number of MUAs lacking a health center site: 2006: 24;
Number of MUAs lacking a health center site: 2007: 19;
Percentage of MUAs lacking a health center site: 2006: 25;
Percentage of MUAs lacking a health center site: 2007: 20.
South census region: Arkansas;
Total number of MUAs: 2006: 92;
Total number of MUAs: 2007: 93;
Number of MUAs lacking a health center site: 2006: 38;
Number of MUAs lacking a health center site: 2007: 33;
Percentage of MUAs lacking a health center site: 2006: 41;
Percentage of MUAs lacking a health center site: 2007: 35.
South census region: Delaware;
Total number of MUAs: 2006: 4;
Total number of MUAs: 2007: 4;
Number of MUAs lacking a health center site: 2006: 0;
Number of MUAs lacking a health center site: 2007: 0;
Percentage of MUAs lacking a health center site: 2006: 0;
Percentage of MUAs lacking a health center site: 2007: 0.
South census region: District of Columbia;
Total number of MUAs: 2006: 9;
Total number of MUAs: 2007: 8;
Number of MUAs lacking a health center site: 2006: 1;
Number of MUAs lacking a health center site: 2007: 1;
Percentage of MUAs lacking a health center site: 2006: 11;
Percentage of MUAs lacking a health center site: 2007: 13.
South census region: Florida;
Total number of MUAs: 2006: 35;
Total number of MUAs: 2007: 35;
Number of MUAs lacking a health center site: 2006: 17;
Number of MUAs lacking a health center site: 2007: 15;
Percentage of MUAs lacking a health center site: 2006: 49;
Percentage of MUAs lacking a health center site: 2007: 43.
South census region: Georgia;
Total number of MUAs: 2006: 147;
Total number of MUAs: 2007: 149;
Number of MUAs lacking a health center site: 2006: 88;
Number of MUAs lacking a health center site: 2007: 78;
Percentage of MUAs lacking a health center site: 2006: 60;
Percentage of MUAs lacking a health center site: 2007: 52.
South census region: Kentucky;
Total number of MUAs: 2006: 78;
Total number of MUAs: 2007: 78;
Number of MUAs lacking a health center site: 2006: 51;
Number of MUAs lacking a health center site: 2007: 45;
Percentage of MUAs lacking a health center site: 2006: 65;
Percentage of MUAs lacking a health center site: 2007: 58.
South census region: Louisiana;
Total number of MUAs: 2006: 73;
Total number of MUAs: 2007: 73;
Number of MUAs lacking a health center site: 2006: 39;
Number of MUAs lacking a health center site: 2007: 33;
Percentage of MUAs lacking a health center site: 2006: 53;
Percentage of MUAs lacking a health center site: 2007: 45.
South census region: Maryland;
Total number of MUAs: 2006: 38;
Total number of MUAs: 2007: 38;
Number of MUAs lacking a health center site: 2006: 11;
Number of MUAs lacking a health center site: 2007: 10;
Percentage of MUAs lacking a health center site: 2006: 29;
Percentage of MUAs lacking a health center site: 2007: 26.
South census region: Mississippi;
Total number of MUAs: 2006: 91;
Total number of MUAs: 2007: 91;
Number of MUAs lacking a health center site: 2006: 18;
Number of MUAs lacking a health center site: 2007: 17;
Percentage of MUAs lacking a health center site: 2006: 20;
Percentage of MUAs lacking a health center site: 2007: 19.
South census region: North Carolina;
Total number of MUAs: 2006: 107;
Total number of MUAs: 2007: 108;
Number of MUAs lacking a health center site: 2006: 59;
Number of MUAs lacking a health center site: 2007: 55;
Percentage of MUAs lacking a health center site: 2006: 55;
Percentage of MUAs lacking a health center site: 2007: 51.
South census region: Oklahoma;
Total number of MUAs: 2006: 65;
Total number of MUAs: 2007: 66;
Number of MUAs lacking a health center site: 2006: 34;
Number of MUAs lacking a health center site: 2007: 30;
Percentage of MUAs lacking a health center site: 2006: 52;
Percentage of MUAs lacking a health center site: 2007: 45.
South census region: South Carolina;
Total number of MUAs: 2006: 68;
Total number of MUAs: 2007: 69;
Number of MUAs lacking a health center site: 2006: 17;
Number of MUAs lacking a health center site: 2007: 15;
Percentage of MUAs lacking a health center site: 2006: 25;
Percentage of MUAs lacking a health center site: 2007: 22.
South census region: Tennessee;
Total number of MUAs: 2006: 101;
Total number of MUAs: 2007: 101;
Number of MUAs lacking a health center site: 2006: 38;
Number of MUAs lacking a health center site: 2007: 35;
Percentage of MUAs lacking a health center site: 2006: 38;
Percentage of MUAs lacking a health center site: 2007: 35.
South census region: Texas;
Total number of MUAs: 2006: 282;
Total number of MUAs: 2007: 283;
Number of MUAs lacking a health center site: 2006: 167;
Number of MUAs lacking a health center site: 2007: 145;
Percentage of MUAs lacking a health center site: 2006: 59;
Percentage of MUAs lacking a health center site: 2007: 51.
South census region: Virginia;
Total number of MUAs: 2006: 92;
Total number of MUAs: 2007: 93;
Number of MUAs lacking a health center site: 2006: 38;
Number of MUAs lacking a health center site: 2007: 34;
Percentage of MUAs lacking a health center site: 2006: 41;
Percentage of MUAs lacking a health center site: 2007: 37.
South census region: West Virginia;
Total number of MUAs: 2006: 57;
Total number of MUAs: 2007: 56;
Number of MUAs lacking a health center site: 2006: 11;
Number of MUAs lacking a health center site: 2007: 9;
Percentage of MUAs lacking a health center site: 2006: 19;
Percentage of MUAs lacking a health center site: 2007: 16.
West census region:
Total number of MUAs: 2006: 485;
Total number of MUAs: 2007: 487;
Number of MUAs lacking a health center site: 2006: 155;
Number of MUAs lacking a health center site: 2007: 149;
Percentage of MUAs lacking a health center site: 2006: 32;
Percentage of MUAs lacking a health center site: 2007: 31.
West census region: Alaska;
Total number of MUAs: 2006: 17;
Total number of MUAs: 2007: 17;
Number of MUAs lacking a health center site: 2006: 0;
Number of MUAs lacking a health center site: 2007: 0;
Percentage of MUAs lacking a health center site: 2006: 0;
Percentage of MUAs lacking a health center site: 2007: 0.
West census region: Arizona;
Total number of MUAs: 2006: 33;
Total number of MUAs: 2007: 33;
Number of MUAs lacking a health center site: 2006: 13;
Number of MUAs lacking a health center site: 2007: 13;
Percentage of MUAs lacking a health center site: 2006: 39;
Percentage of MUAs lacking a health center site: 2007: 39.
West census region: California;
Total number of MUAs: 2006: 165;
Total number of MUAs: 2007: 167;
Number of MUAs lacking a health center site: 2006: 33;
Number of MUAs lacking a health center site: 2007: 31;
Percentage of MUAs lacking a health center site: 2006: 20;
Percentage of MUAs lacking a health center site: 2007: 19.
West census region: Colorado;
Total number of MUAs: 2006: 42;
Total number of MUAs: 2007: 42;
Number of MUAs lacking a health center site: 2006: 9;
Number of MUAs lacking a health center site: 2007: 9;
Percentage of MUAs lacking a health center site: 2006: 21;
Percentage of MUAs lacking a health center site: 2007: 21.
West census region: Hawaii;
Total number of MUAs: 2006: 4;
Total number of MUAs: 2007: 4;
Number of MUAs lacking a health center site: 2006: 0;
Number of MUAs lacking a health center site: 2007: 0;
Percentage of MUAs lacking a health center site: 2006: 0;
Percentage of MUAs lacking a health center site: 2007: 0.
West census region: Idaho;
Total number of MUAs: 2006: 35;
Total number of MUAs: 2007: 35;
Number of MUAs lacking a health center site: 2006: 15;
Number of MUAs lacking a health center site: 2007: 14;
Percentage of MUAs lacking a health center site: 2006: 43;
Percentage of MUAs lacking a health center site: 2007: 40.
West census region: Montana;
Total number of MUAs: 2006: 44;
Total number of MUAs: 2007: 44;
Number of MUAs lacking a health center site: 2006: 34;
Number of MUAs lacking a health center site: 2007: 33;
Percentage of MUAs lacking a health center site: 2006: 77;
Percentage of MUAs lacking a health center site: 2007: 75.
West census region: Nevada;
Total number of MUAs: 2006: 8;
Total number of MUAs: 2007: 8;
Number of MUAs lacking a health center site: 2006: 4;
Number of MUAs lacking a health center site: 2007: 4;
Percentage of MUAs lacking a health center site: 2006: 50;
Percentage of MUAs lacking a health center site: 2007: 50.
West census region: New Mexico;
Total number of MUAs: 2006: 36;
Total number of MUAs: 2007: 36;
Number of MUAs lacking a health center site: 2006: 5;
Number of MUAs lacking a health center site: 2007: 4;
Percentage of MUAs lacking a health center site: 2006: 14;
Percentage of MUAs lacking a health center site: 2007: 11.
West census region: Oregon;
Total number of MUAs: 2006: 42;
Total number of MUAs: 2007: 42;
Number of MUAs lacking a health center site: 2006: 17;
Number of MUAs lacking a health center site: 2007: 16;
Percentage of MUAs lacking a health center site: 2006: 40;
Percentage of MUAs lacking a health center site: 2007: 38.
West census region: Utah;
Total number of MUAs: 2006: 17;
Total number of MUAs: 2007: 17;
Number of MUAs lacking a health center site: 2006: 7;
Number of MUAs lacking a health center site: 2007: 7;
Percentage of MUAs lacking a health center site: 2006: 41;
Percentage of MUAs lacking a health center site: 2007: 41.
West census region: Washington;
Total number of MUAs: 2006: 31;
Total number of MUAs: 2007: 31;
Number of MUAs lacking a health center site: 2006: 12;
Number of MUAs lacking a health center site: 2007: 12;
Percentage of MUAs lacking a health center site: 2006: 39;
Percentage of MUAs lacking a health center site: 2007: 39.
West census region: Wyoming;
Total number of MUAs: 2006: 11;
Total number of MUAs: 2007: 11;
Number of MUAs lacking a health center site: 2006: 6;
Number of MUAs lacking a health center site: 2007: 6;
Percentage of MUAs lacking a health center site: 2006: 55;
Percentage of MUAs lacking a health center site: 2007: 55.
U.S. territories:
Total number of MUAs: 2006: 79;
Total number of MUAs: 2007: 79;
Number of MUAs lacking a health center site: 2006: 0;
Number of MUAs lacking a health center site: 2007: 0;
Percentage of MUAs lacking a health center site: 2006: 0;
Percentage of MUAs lacking a health center site: 2007: 0.
U.S. territories: American Samoa;
Total number of MUAs: 2006: 4;
Total number of MUAs: 2007: 4;
Number of MUAs lacking a health center site: 2006: 0;
Number of MUAs lacking a health center site: 2007: 0;
Percentage of MUAs lacking a health center site: 2006: 0;
Percentage of MUAs lacking a health center site: 2007: 0.
U.S. territories: Guam;
Total number of MUAs: 2006: 0;
Total number of MUAs: 2007: 0;
Number of MUAs lacking a health center site: 2006: n/a;
Number of MUAs lacking a health center site: 2007: n/a;
Percentage of MUAs lacking a health center site: 2006: n/a;
Percentage of MUAs lacking a health center site: 2007: n/a.
U.S. territories: Northern Mariana Islands;
Total number of MUAs: 2006: 0;
Total number of MUAs: 2007: 0;
Number of MUAs lacking a health center site: 2006: n/a;
Number of MUAs lacking a health center site: 2007: n/a;
Percentage of MUAs lacking a health center site: 2006: n/a;
Percentage of MUAs lacking a health center site: 2007: n/a.
U.S. territories: Puerto Rico;
Total number of MUAs: 2006: 72;
Total number of MUAs: 2007: 72;
Number of MUAs lacking a health center site: 2006: 0;
Number of MUAs lacking a health center site: 2007: 0;
Percentage of MUAs lacking a health center site: 2006: 0;
Percentage of MUAs lacking a health center site: 2007: 0.
U.S. territories: U.S. Virgin Islands;
Total number of MUAs: 2006: 3;
Total number of MUAs: 2007: 3;
Number of MUAs lacking a health center site: 2006: 0;
Number of MUAs lacking a health center site: 2007: 0;
Percentage of MUAs lacking a health center site: 2006: 0;
Percentage of MUAs lacking a health center site: 2007: 0.
Source: GAO analysis of Health Resources and Services Administration
and U.S. Census Bureau data.
[End of table]
[End of section]
Footnotes:
[1] The Health Resources and Services Administration designates MUAs
based on a geographic area, such as a county, while MUPs are based on a
specific population that demonstrates economic, cultural, or linguistic
barriers to primary care services.
[2] In 2006, Health Center Program grants made up about 20 percent of
all health center grantees' revenues. Other federal benefits include
enhanced Medicaid and Medicare payment rates and reduced drug pricing.
[3] GAO, Health Centers: Competition for Grants and Efforts to Measure
Performance Have Increased, [hyperlink,
http://www.gao.gov/products/GAO-05-645] (Washington, D.C.: July 13,
2005).
[4] This new access point competition is described as open because
applicants were not required to be located in certain geographic areas
in order to apply, but were required to demonstrate in the proposal
that the health center and its associated sites would serve, in whole
or in part, an MUA or MUP.
[5] GAO, Health Resources and Services Administration: Many Underserved
Areas Lack a Health Center Site, and the Health Center Program Needs
More Oversight, [hyperlink, http://www.gao.gov/products/GAO-08-723]
(Washington, D.C.: Aug. 8, 2008).
[6] In our report, we considered the District of Columbia a state.
[7] 42 U.S.C. § 254b(a)(1). In contrast, HRSA grantees that operate
health center sites targeting migrant farmworkers, public housing
residents, and the homeless are not required to serve all residents of
their service areas. 42 U.S.C. § 254b(a)(2). Because the UDS does not
allow separate identification of individual health center sites for
grantees that receive a combination of community health center funding
and health center funding to target migrant farmworkers, public housing
residents, or the homeless (27 percent of all grantees in 2006), we
could not distinguish sites supported exclusively by community health
center funding from sites supported exclusively by health center
funding for migrant farmworkers, public housing residents, or the
homeless. Therefore, we included all sites associated with health
center grantees that received, at a minimum, community health center
funding (90 percent of all grantees in 2006). As a result, some health
center sites included in our analysis are not sites exclusively
supported by community health center funding.
[8] Some organizations choose not to apply for funding under the Health
Center Program; however, they seek to be recognized by HRSA as
federally qualified health center look-alikes, in large part, so that
they may become eligible to receive other federal benefits, such as
enhanced Medicare and Medicaid payment rates and reduced drug pricing.
For our purposes, federally qualified health center look-alike sites
are referred to as health center look-alike sites.
[9] Because the UDS had not been updated for 2007 at the time of our
review, we could not determine whether any health center sites that
were in operation in 2006 were no longer operating in 2007; therefore,
we assumed that all health center sites operating in 2006 were still
operating in 2007.
[10] When we included the 294 health center look-alike sites operating
in 2006, we found that the percentage of MUAs lacking either a health
center site or health center look-alike site in 2006 was 46 percent (or
1,564 MUAs).
[11] When we included the 265 health center look-alike sites operating
in 2007, we found that 1,462 MUAs lacked a health center site or health
center look-alike site in 2007, which did not change the overall
percentage (43 percent) of MUAs in 2007 that lacked a health center
site.
[End of section]
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