Eliminating Duplicative Government Spending

The Government Accountability Office was tasked to find areas of duplication within the federal government. They discovered 81 potential areas of overlap, three of which refer to health care and public health.

The General Accountability Office was asked to report annually on federal programs, agencies, offices, and initiatives that have duplicative goals or activities.  The objectives of this March 2011 report were to: (1) summarize areas of duplication, overlap or fragmentation, (2) devise the actions needed to address such conditions, (3) estimate the potential financial and other benefits of eliminating duplication, and (4) highlight other opportunities for potential costs savings or enhanced federal revenues.

While the report discussed all aspects of the federal government, this review focuses only on topics related to health care and public health.

One area of particular concern is the overlapping health care goals of the Departments of Defense (DOD) and Veterans Affairs (VA).  As the two largest health care systems in the nation, these two federal departments together provide care to a specialized population: active duty service members, beneficiaries of active duty personnel, and veterans.  The GAO found that the DOD and the VA have many common health care business needs, but yet have separate efforts for the modernization of their electronic health record systems and contracting for prescription drugs.   The GAO recommends that the departments create a joint strategic plan addressing joint health information technology (IT) solutions and that they identify joint health IT investments that meet their common needs.  As service members transition to veteran status, such moves would allow for comprehensive and seamless access to information.

The GAO also recommends that the two departments should continue and increase joint contracting for generic drugs and should analyze whether cost savings can be achieved through joint contracting for brand name pharmaceuticals.

Other areas of concern include our nation’s public health strategies for awareness and emergency response. The Department of Health and Human Services (HHS) is responsible for coordinating nationwide efforts to address public health emergencies.  There is also a need to improve the use of information technology to collect analyze and share public health data.  The GAO recommends that HHS develop and implement an overall strategy to achieve unified electronic nationwide public health situational awareness.

Commentary

Duplication, overlapping, and fragmentation inhibit much of the progress that would otherwise be necessary to achieve efficient and adequate universal coverage.  Similar recommendations could be made for joint technology and contracting for Medicaid, Medicare, and the Federal Employee Benefits program.  Though the patient population is not shared amongst those three federal programs like that of DOD and VA, the federal government remains a single party that would benefit from interdepartmental collaboration.  Incentives would have to be created to entice private health care systems to do the same level of collaboration.  However, establishing a baseline for technology and/or information sharing might be a plausible function for the government to undertake for the greater good of the nation.  Information and processes must be shared in order to optimize the care provided and to decrease the overall costs to the system.

Government Accountability Office.  “Opportunities to Reduce Potential Duplication in Government Programs, Save Tax Dollars, and Enhance Revenue.”  March 2011; Pages 79-91.

by

Kameron L. Matthews, MD, Esq.