Despite 3 decades of federal efforts, the number of areas HHS has classified as underserved using these systems has not decreased. But until, and depending on how, the Secretary defines the types of areas needing rural health clinics, HHS will continue to rely on flawed HPSA and MUA systems that assume providing services to anyone living in a designated shortage area will improve access to care. In the meantime, new legislation continues to require the use of these systems, thereby increasing the problem. Implementation of the Government Performance and Results Act Provides an Opportunity to Address Identified Problems

To make the Rural Health Clinic program and other federal programs more accountable for improving access to primary care, HHS will have to devise a better management approach to measure need and evaluate individual program success in meeting this need. If effectively implemented, the management approach called for under the Results Act offers such an opportunity. Using information on how well programs are working to improve access in communities, program managers can decide whether federal intervention has been successful and can be discontinued, or if other strategies for addressing access barriers that still exist in communities would provide a more effective solution. Establishing performance goals and measures such as the following could go far to improve accountability in HHS’ primary access programs. Conclusion

Although the Rural Health Clinic program and other federal programs help to provide health care services to many people, the magnitude of federal investment creates a need to hold these programs accountable for improving access to primary care.
Why GAO Did This Study

GAO discussed the Rural Health Clinic Program in the broader context of GAO's past reviews of federal efforts to improve access to primary health care, focusing on: (1) the common problems GAO found and some recent initiatives to address them; and (2) how the type of management changes called for under the Government Performance and Results Act of 1993 can help the Rural Health Clinic and related programs improve accountability.

What GAO Found

GAO noted that: (1) GAO's work has identified many instances in which the Rural Health Clinic program and other federal programs have provided aid to communities without ensuring that this aid has been used to improve access to primary care; (2) in some cases, programs have provided more than enough assistance to eliminate the defined shortage, while needs in other communities remain unaddressed; (3) GAO's work has identified a pervasive cause for this proa reliance on flawed systems for measuring health care shortages; (4) these systems often do not work effectively to identify which programs would work best in a given setting or how well a program is working to meet the needs of the underserved once it is in place; (5) for several years, the Department of Health and Human Services has tried unsuccessfully to revise these systems to address these problems; and (6) the goal-setting and performance measurement discipline available under the Results Act, however, appears to offer a suitable framework for ensuring that programs are held accountable for improving access to primary care.