HHS has two such systems: The Health Professional Shortage Area (HPSA) system identifies underservice caused by a shortage of health professionals, and the Medically Underserved Area (MUA) system more broadly identifies areas and populations not receiving adequate health services for any reason, including provider shortages. To review the extent to which the HPSA and MUA systems identify areas with primary care shortages, we reviewed past evaluations of the criteria and methodology for designating primary care HPSAs and MUAs and discussed the results with responsible HHS officials, identified the number of primary care providers in HPSAs and compared it to the number reported by the HPSA system, selected a random sample of primary care HPSA applications and reviewed whether designations were appropriate and accurately reflected in the HPSA database, and compared how often the HPSA and MUA data were updated with requirements in the law and HHS policy. Systems Do Not Consider All Primary Care Resources in Making Shortage Determinations

Both systems rely on a population-to-physician ratio in establishing the need for additional primary care providers. MUA Methodology Is Limited in Ability to Identify Underserved Areas

The MUA methodology has a number of flaws that limit its ability to accurately identify geographic areas and populations that have the greatest shortages of health care services. 2.1). Designation Systems Do Not Provide Information Necessary to Target Funding to the Underserved

Even when the HPSA and MUA designations identify needy areas, they generally do not provide the type of information needed by federal programs to target assistance best suited to meet a location’s particular needs. The needed improvements may be difficult and costly, and all but one federal program already have their own screening processes in place that may be more easily modified to better match federal resources with the needs of underserved communities. Second, they are based on flawed methodologies that have not been effective at specifically identifying which parts of the population are underserved and why. The Bureau of Primary Health Care is proposing changes to consolidate and streamline the administrative processes of the two systems. However, they believe that maintaining a national system is needed for developing planning documents and monitoring primary care access. While we agree, HHS already has another effort under way that may serve this purpose.
Why GAO Did This Study

GAO reviewed the Department of Health and Human Services' (HHS) systems for identifying geographical areas where access to medical care is limited, focusing on: (1) how well the systems identify areas with primary care shortages; (2) how well the systems target federal funding to the underserved; and (3) whether the HHS proposal to combine the systems would lead to improvements.

What GAO Found

GAO found that: (1) the two HHS systems do not reliably identify areas with primary care shortages or help target federal resources to the underserved; (2) the systems have widespread data and methodology problems which severely limit their ability to pinpoint needy areas; (3) both systems tend to overstate the need for additional primary care providers because they do not consider all of the categories of providers already in place; (4) the Health Professional Shortage Area System (HPSA) does not consider the extent to which available resources are being used; (5) the Medically Underserved Area System (MUA) is limited in its ability to identify underserved areas and populations; (6) neither system identifies the specific subpopulations that have difficulty obtaining medical care; (7) while the systems can sometimes accurately identify needy areas, they do not provide the necessary data to determine which programs are best suited to those areas; (8) the proposed consolidation and streamlining of the systems is not likely to solve system problems, since the underlying causes of the problems have not been addressed; (9) it may be more cost-effective to modify individual programs and application processes to identify where needs exist and the appropriate program to meet those needs and to target resources better; and (10) HHS officials believe that they need to maintain a national shortage designation system to monitor primary care access, but HHS has another initiative under way that could serve those purposes.