Summary: The Indian Health Service (IHS), a component of the Health Service Administration (HSA) of the Department of Health, Education, and Welfare (HEW), is responsible for providing comprehensive health care to Indians and Alaska Natives. The Alaska Area Native Health Service (AANHS) is the IHS component responsible for providing health care services to Alaska Natives. The Indian Self-Determination and Education Assistance Act permits Indian tribes and Alaska Natives to assume control over Federal Indian programs. Under the Act, tribes must request to contract with the Secretaries of the Interior and HEW to plan and conduct programs which the Bureau of Indian Affairs and/or IHS administers for Indians and Alaska Natives. Alaska Natives have formed nonprofit Native health organizations in each of the 12 regions of Alaska which were established by the Alaska Native Claims Settlement Act. AANHS has contracted directly with the 12 Native health organizations to provide a variety of health services to Alaska Natives. Pursuant to a congressional request, GAO attempted a comparison of the costs IHS incurred in contracting with Native health organizations for administering health service programs with the costs IHS previously incurred in administering such programs directly.
A meaningful comparison could not be made because of the unavailability of accounting records, the creation of new programs, the frequency with which funds were shifted among programs, the lack of a system within IHS for assigning indirect costs to individual programs, and the fact that many of the health service programs administered by Native health organizations had previously been administered by Natives under earlier legislation. However, the study revealed a number of problems which strained the working relationships among AANHS and several Native health organizations which in some cases either delayed the start of new health service programs or disrupted ongoing programs. Native health organizations believed that IHS and AANHS were not supporting the intent of the Indian Self-Determination Act because IHS had not developed a system for identifying all of its costs and for assigning total costs to individual programs and program segments; (2) IHS and AANHS did not provide information promptly to facilitate contract negotiations and agreement before the beginning of the contract period and to reduce frequent contract modifications; and (3) unnecessarily restrictive provisions were included in the contracts. IHS and AANHS stated that procurement regulations and the need to satisfy their fiscal and program accountability responsibilities required that contract provisions be explicit in stating the tasks and costs that will be incurred under the contracts and that contracts include certain controls.
