Summary: GAO reviewed the factors that contributed to the low utilization of inpatient services at nine small Indian Health Services (IHS) hospitals and evaluated whether other cost-effective alternatives existed.
At the nine hospitals visited, GAO found that the inpatient workload was low and the services offered were limited when compared to those available at nearby community hospitals. Because of the limited inpatient services, a portion of the inpatient workload is referred to community hospitals which generally have the capacity to absorb the hospitals' total inpatient workload. The Department of Health and Human Services (HHS) plans to replace or modernize seven of the hospitals reviewed at a total estimated cost of $66 million. In addition, an estimated $6 million is to be used to correct structural deficiencies at all nine hospitals, and $15 million is to be used for construction of personnel quarters at four of them. GAO believes that some of the planned capital expenditures could be avoided by: (1) limiting expenditures to those required to maintain outpatient and emergency care facilities at the nine locations; and (2) obtaining inpatient care under contract from nearby community hospitals. The available cost data suggest that obtaining inpatient care for IHS beneficiaries from the community hospitals could be less costly. Discontinuing inpatient care at the hospitals may raise concern or opposition from tribal officials, and there may be some transition difficulties; however, phasing out IHS inpatient care by making greater use of community hospitals appears feasible as long as adequate funds for contract health care are available.
