JA Cramer

Document Type



The Resource Allocation Criteria (RAC) began to develop in 1972, responding to management requirements of the Indian Health Service (IHS). The RAC is now the principal management tool of the IHS Manpower Management Program, which justifies all manpower-related budgetary requests to the Department of Health and Human Services (DHHS). RAC fulfills its obligations by identifying necessary tasks to provide quality resources for each segment of the health care system. The purpose of this study was to determine the reliability of the data inputs to RAC, the degree to which the quality of the input affects the reliability of the output. and Identification of means to improve the quality of input data. The study first identified input data elements through the use of archival (RAC) records and interviews with IHS personnel. From this data, flow charts and profile sheets were compiled. IHS Program/Area Offices site visits were then initiated. Here, patient records were sampled, meetings with site personnel to review methods in use were held, and local finance and contract personnel were interviewed to determine volume of and tracking method for services. Using these data, flow charts were developed and data estimates were constructed using all previously gathered material. From these data estimates, the accuracy of RAC input data was compared with the actual data collected and the constructed data estimates. The findings of the study included: 1) as a result of perceived undercounting, population data from IHS suffers from a lack of confidence at the Area Offices; 2) both inpatient and outpatient data are suspect because of the practice of issuing one patient more than one patient number and, conversely issuing the same patient number to more than one patient; 3) illegible record entries hinder accurate patient data gathering; 4) a high turnover in record keeping personnel; 5) a significantly lower error rate in inpatient data than in outpatient data; 6) a number of inpatient and outpatient records never enter the IHS data system; 7) alcoholism is not always reported as the cause of medical attention in projecting demand for contract health services; 8) RAC does not adequately project the additional need for P.L. 638 contracting; 9) data is often lacking from HSA-43 and HSA-64 reporting forms; 10) contract health service providers are not always audited; 11) many contract service bills are submitted after the close of the fiscal year; 12) RAC staffing tables are relatively insensitive from a statistical perspective; and 13) Service Units and Area Offices are more accurate predictors of direct service needs than are contract providers. Numerous recommendations are made concerning: 1) the national decennial census; 2) population migration and projections; 3) a unique patient identification numbering system; 4) inpatient and outpatient data verification procedures; 5) feasibility of developing the HSA-44-1 and the HSA-406 as clinical management tools; 6) an inventory of the patient record system; 7) Area Offices review systems checks; 8) the accuracy of patient data; 9) use of HSA-406 forms during itinerant visits; 10) a training program for Community Health Aides (CHAs); 11) reporting alcoholism as a primary diagnosis; 12) projected utilization of contract services to actual contract services needs; 13) a method of identifying and projecting P.L. 638 costs; 14) efforts to obtain all contractor invoices before the end of the fiscal year; 15) algorithms that support staffing tables and then perform another sensitivity analysis; and 21) standardization of collection, reporting, and recording parameters of projected and actual data and ensure a consistent application in developing RAC input data.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-67).