Congressional Monitoring of Planning for Indian Health Care Facilities Is Still Needed

GAO studied the adequacy of the Indian Health Service's hospital planning activities. The Service is responsible for providing comprehensive health care to Indians and Alaska Natives. In May 1977, GAO reported to Congress that the Service's methodology for determining the number of hospital beds needed in the Navajo area would result in too many acute care beds. Because the Service used the same methodology for planning hospitals throughout its system, GAO estimated that similar problems probably existed elsewhere. Thus, the Appropriations Committees recommended, and Congress approved, a moratorium on the use of planning funds until the Service recognized the declining need for acute care beds. However, after the Service made some revisions to its planning procedures, Congress provided limited funding for two projects, the Chinle and the Talequah hospitals, that were being funded when the moratorium was imposed.

The Service's revised methodology appears to be a reasonable method for determining the need for acute care beds. However, the assumptions used in applying this methodology can result in overestimating or underestimating future demand. GAO believes the Service needs to further address the problems of availability and acceptability of health services in the Navajo area. Additionally, the revisions the Service made in its hospital planning and construction procedures are not completely responsive to the congressional directives. In an effort to limit cost overruns and make the Service's planning procedures more responsive, Congress has limited the number of acute care beds and the amount of gross square footage for the Chinle hospital. However, the Service has plans which call for a hospital and leased annex which, in total, will exceed the square footage limitation of the Chinle hospital, and estimates that construction costs on the Chinle hospital will exceed the original estimate by $6 million.

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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