Because resource allocation is a sensitive and complex undertaking in VA’s health care system, VA has made a considerable investment in it. Another important aspect of the RPM system is its ability to forecast workload changes. The System Does Not Address Veterans’ Unequal Access to Care

Part of VA’s original plan for RPM was to use it to help alleviate inconsistencies in veterans’ access to outpatient care—a plan that has not materialized. Facilities cannot efficiently adjust to large budget changes. First, given that the initial 2 years of the system’s implementation were intended to help facilities adjust to the new process, the Deputy Under Secretary for Health told us in September 1995 that VA was planning to reallocate a significantly larger amount of money for the fiscal year 1996 facility budgets based on RPM. Furthermore, officials indicated that they were implementing a Decision Support System to better coordinate VA’s clinical and financial data systems and allow VA to compute more accurately the costs of specific services provided to each patient. Recommendations

We recommend that the Secretary of Veterans Affairs direct the Under Secretary for Health to link the resource allocation process to the strategic planning process in the VISN structure so that (1) allocations are more clearly associated with VA’s long-range goals, performance standards, and workload priorities; and (2) facility and VISN managers are given short- and long-range financial objectives; institute a formal review and evaluation process within the resource allocation system to examine the reasons for cost variations among facilities and VISNs; establish a process for evaluating non-RPM patient care funds to determine whether they can be included in the RPM allocation system, including exploring options for using existing financial management systems to capture data on the provision of non-RPM allocated funds by facility and program area; and explore options for using existing or improved databases to (1) understand the extent to which veterans within the same priority categories have consistent access to care within the VA health care system and (2) include such data in VA’s resource allocation system to help ensure that veterans have consistent access to care throughout the system. VA’s Resource Planning and Management System

The Resource Planning and Management system is the management decision process VA uses to allocate most of its resources and to compare VA medical facilities’ performance. The data also show changing facility workloads.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) resource allocation system, focusing on the: (1) extent to which VA resources are distributed equally among VA facilities; and (2) causes of unequal resource allocations among VA health care facilities.

What GAO Found

GAO found that: (1) the VA resource allocation system enables VA to identify potential inequities in resource allocations and forecast facility workload changes, but VA has made only minimal changes in facilities' funding levels; (2) there is a significant difference between comparable health care facilities' operating costs and patient workloads; (3) VA has not used its resource planning and management system (RPM) to ensure that resources are allocated to facilities within the same priority category; (4) VA excluded over $4 billion of its medical care appropriation from the RPM process during the first 2 years of RPM because it wanted to give VA facilities more time to adjust to the reallocation process and large budget changes; (5) the RPM system does not address veterans' unequal access to outpatient care; and (6) VA plans to reallocate a larger portion of its fiscal year 1996 facility budgets based on the RPM process and implement a decision support system to better compute the costs of specific services provided to each patient.