Summary: The Department of Health and Human Services (HHS) has initiated and supported grant programs aimed at increasing primary health care capacity in medically underserved areas (MUA), preventing and treating substance abuse, and providing services to deal with mental illness. Each of these programs requires that an assessment of the need for the proposed services be made. GAO reviewed the needs assessment processes used to justify funding grantees under the rural and urban health initiatives and several other health programs administered by HHS.
The MUA designation criteria HHS used to establish grantee funding eligibility were developed as a rough indicator of the adequacy of medical service in an area and had several weaknesses. Despite these weaknesses, HHS applied the criteria, without change, as the specific measure of medical underservice for rural and urban community health center programs. The review of needs assessment preparation and evaluation shows that: (1) HHS had provided little guidance on how grant applicants should meet the legislative requirement of performing a needs assessment; (2) many grantees have approached fulfilling the requirement in a manner which seems to minimize the apparent need for a health center without adequate regard for the validity of data used and opposing views that raise fundamental questions about need; and (3) HHS grant application reviews are inadequate, and HHS seems to rely heavily on the MUA designation of the proposed service area, which was intended only to be a rough indicator of the adequacy of medical service in an area. GAO recognizes that many areas of the Nation have problems with the availability of and access to health services. However, in the opinion of GAO, the need determination mechanisms for the community health center programs, as presently structured and operated, provide little assurance that MUA's have been appropriately identified and are not an adequate basis for establishing specific urban and rural health centers.
