Summary

Recent studies on the District of Columbia's health care system have concluded that the city's health care problems are aggravated by such social factors as high rates of poverty, crime, substance abuse, and unemployment. These factors account for the sizable numbers of persons who do not seek preventive health care and cannot pay for medical treatment, the inappropriate use of D.C. General Hospital for primary care, and the many trauma care patients at area hospitals. To help Congress evaluate various restructuring proposals being considered for the District, this report discusses the District's health care budget and the composition of the District's health care system, including the number of Medicaid recipients and uninsured and the distribution of hospitals and clinics.

GAO found that: (1) the District's Department of Human Services includes the Commission on Public Health, Commission on Health Care Finance, the Commission on Mental Health Services, and the Commission on Social Services; (2) the District's health care expenditures increased 25 percent between fiscal years (FY) 1991 and 1994; (3) in FY 1994, the District spent $1.246 billion on health care, which was about 27 percent of its total budget; (4) the District's Medicaid expenses grew 53 percent between FY 1991 and 1994, making it the fastest growing part of its health care system; (5) the District does not collect specific cost data on its health care programs and the lack of data makes it difficult to control its health care costs; (6) Saint Elizabeth's Hospital needs repairs estimated in 1985 at $119 million; (7) the District does not coordinate fully among D.C. General Hospital, the hospital-run clinics, and the neighborhood clinics; (8) of the District's $309 million in subsides that it provided between FY 1991 and 1994, $75 million were loans to cover large operating deficits; (9) in 1994, D.C. General Hospital provided $78 million in uncompensated care; and (10) several studies have recommended that D.C. General Hospital be closed because of the renovations that are needed, its inefficient operations, and perceived low-care quality.