Major Management Challenges and Program Risks

This publication is part of GAO's performance and accountability series which provides a comprehensive assessment of government management, particularly the management challenges and program risks confronting federal agencies. Using a "performance-based management" approach, this landmark set of reports focuses on the results of government programs--how they affect the American taxpayer--rather than on the processes of government. This approach integrates thinking about organization, product and service delivery, use of technology, and human capital practices into every decision about the results that the government hopes to achieve. The series includes an overview volume discussing governmentwide management issues and 20 individual reports on the challenges facing specific cabinet departments and independent agencies. The reports take advantage of the wealth of new information made possible by management reform legislation, including audited financial statements for major federal agencies, mandated by the Chief Financial Officers Act, and strategic and performance plans required by the Government Performance and Results Act. In a companion volume to this series, GAO also updates its high-risk list of government operations and programs that are particularly vulnerable to waste, fraud, abuse, and mismanagement.

GAO noted that: (1) many VA facilities are deteriorating, inappropriately configured, or no longer needed because of their age and VA's shift in emphasis from providing specialized inpatient services to providing primary care in an outpatient setting; (2) despite eliminating about one-half of VA's hospital beds, excess capacity remains; (3) VA lacks accurate, reliable, and consistent information for measuring the extent to which: (a) veterans are receiving equitable access to health care across the country; (b) all veterans enrolled in VA's health care system are receiving the care they need; and (c) VA is maintaining its capacity to care for special populations; (4) VA does not know how its rapid move toward managed care is affecting the health status of veterans because measures of the effects of its service delivery changes on patient outcomes have not been established; (5) other public and private health care providers have recognized the necessity--and the difficulty--of creating such criteria and instruments; (6) in managing non-health care benefits programs, VA needs to overcome a variety of difficulties; (7) VA cannot ensure that its veterans' disability compensation benefits are appropriately and equitably distributed because its disability rating schedule does not accurately reflect veterans' economic losses resulting from their disabilities; (8) also, VA is compensating veterans for diseases that are neither caused nor aggravated by military service; (9) VA has made progress in addressing year 2000 challenges, but still has a number of associated issues to address; (10) VA lacks adequate control and oversight of access to its computer systems and has not yet institutionalized a disciplined process for selecting, controlling, and evaluating information technology investments as required by the Clinger-Cohen Act; (11) VA developed strategic goals covering all its major programs and included objectives, strategies, and performance goals to support its strategic goals; and (12) VA has made progress in developing a framework for managing and evaluating changes in service delivery.