1). HRSA designates three types of HPSAs: geographic, population-group, and  facility. Geographic HPSAs include entire counties, a portion of a county,  or a group of contiguous counties. HPSAs Are Located in Every State and Are Used by Multiple Federal Programs

More than 5,500 HPSAs were located throughout the country as of  September 2005. Numerous federal programs have used these HPSA designations to  allocate their programs’ resources or provide benefits, which is an  incentive for obtaining and retaining the HPSA designation. We estimated that slightly more than half (3,032) of these HPSAs  were designated for geographic areas or population groups. Federal Programs Using HPSA Designations

Although the HPSA designation system was originally used to designate  areas for placement of providers through NHSC programs, the HPSA  designation, and in some cases the HPSA score, have since been used by  more than 30 federal programs to allocate resources or provide benefits. The use of the HPSA designation by more than 30 federal programs to  allocate resources or provide benefits is an incentive for obtaining and  retaining a HPSA designation, even if the HPSA does not want or need  additional primary care providers. These six reports were consistent with what we  reported in 1995. Recognizing the shortcomings in the HPSA designation system identified  by available research and our prior work, HHS has been working on a  proposal for a revised designation system since 1998. Many Health Centers and Rural Health Clinics Did Not Benefit from Automatic HPSA Designation

Many health centers and rural health clinics did not benefit from  automatic designation as facility HPSAs because they were located in  geographic or population-group HPSAs. Most health centers also received  a HPSA score associated with the automatic designation that was too low  to qualify them for programs that required a minimum HPSA score in 2005,  although they qualified for programs that did not have such a requirement. Of the relatively few rural health clinics that chose to certify that they  would treat anyone regardless of ability to pay and, as a result, received  the automatic designation as facility HPSAs, most also received scores too  low to qualify for benefits from certain programs that required a higher  HPSA score. Few Rural Health Clinics Have Received Automatic HPSA Designation as Facility HPSAs

As of September 2005, 590 (16 percent) of the 3,637 rural health clinics in  the United States had received automatic designation as facility HPSAs. Conclusions

Many federal programs continue to rely on HPSA designations to allocate  federal resources or provide benefits, even though shortcomings we and  others have reported since 1995 have not been addressed. Recommendations for Executive Action

We recommend that the Secretary of Health and Human Services take the  following two actions: (1) publish a list of designated HPSAs in the Federal  Register or otherwise remove, through Federal Register notification, the  HPSA designations for those HPSAs that no longer meet the criteria or  have not provided updated data in support of their designations and   (2) complete and publish HHS’s proposal to revise the HPSA designation  system and address the shortcomings that have been identified in the  current methodology for designating HPSAs. Appendix I: Scoring of Health Professional Shortage Areas

Each designated health professional shortage area (HPSA) receives a  score that the Department of Health and Human Services’s (HHS) Health  Resources and Services Administration (HRSA) uses to rank its shortage  of primary care providers, or need, relative to other HPSAs. We focused our review  on the HPSA criteria that were in effect both in 2002 when the Health Care  Safety Net Amendments were enacted and at the time of our review. Health Care Shortage Areas: Designations Not a Useful Tool for  Directing Resources to the Underserved. GAO/HEHS-95-200.Washington,  D.C.: September 8, 1995.
Why GAO Did This Study

To identify areas facing shortages of health care providers, the Department of Health and Human Services (HHS) relies on its health professional shortage area (HPSA) designation system. HHS designates geographic, population-group, and facility HPSAs. HHS also gives each HPSA a score to rank its need for providers relative to other HPSAs. The Health Care Safety Net Amendments of 2002 required GAO to report on the HPSA designation system. GAO reviewed (1) the number and location of HPSAs and federal programs that use HPSA designations to allocate resources or provide benefits, (2) available research on HPSA designation criteria and methodology, and (3) the impact of a 2002 provision that automatically designates federally qualified health centers and certain rural health clinics as facility HPSAs. GAO obtained and analyzed HHS's data on primary care HPSA designations as of September 2005 and January 2006 and identified reports on HPSA criteria and methodology through a literature search of peer-reviewed journals and other reports published since 1995.

What GAO Found

GAO identified more than 5,500 HPSAs designated throughout the United States as of September 2005; multiple federal programs relied on these designations to allocate resources or provide benefits. GAO estimated that slightly more than half of the HPSAs were designated for geographic areas--such as counties or portions of counties--or population groups, such as migrant farmworkers. The remaining HPSAs were designated for facilities, such as rural health clinics. In fiscal year 2005, more than 30 federal programs relied on HPSA designations, and in some cases HPSA scores, to allocate resources or provide benefits. The use of the HPSA designation by numerous federal programs to allocate resources or provide benefits is an incentive for obtaining and retaining a HPSA designation. Published reports have pointed to shortcomings in the methodology used for designating HPSAs. These reports' observations were consistent with findings in GAO's 1995 report, Health Care Shortage Areas: Designations Not a Useful Tool for Directing Resources to the Underserved, (GAO/HEHS-95-200, Sept. 8, 1995), including that HHS's methodology did not account for certain types of primary care providers already serving in a HPSA, which can result in an overstatement of the provider shortage. Recognizing the shortcomings of the current methodology, HHS has been working since 1998 on a proposal to revise the designation system. In addition, some HPSAs that no longer meet the criteria have retained their HPSA designation and possibly received benefits from federal programs that rely on that designation. HHS has not complied since 2002 with the statutory requirement to annually publish a list of designated HPSAs in the Federal Register--which would remove the designations of those HPSAs that are no longer listed. Many federally qualified health centers and rural health clinics did not benefit from automatic designation as facility HPSAs because they were located in geographic or population-group HPSAs. In addition, most of the more than 1,600 federally qualified health centers received HPSA scores associated with the automatic designation that were too low to qualify them for certain federal programs that required a minimum HPSA score in 2005, although they qualified for other programs that did not have such a requirement. Of the 590 rural health clinics that chose to certify that they would treat anyone regardless of ability to pay and, as a result, received automatic designation as facility HPSAs, most also received associated HPSA scores too low to qualify for benefits from certain federal programs that required a higher HPSA score.