What the GAO Found

The Native Hawaiian Health Care Systems Program, administered by the Health Resources and Services Administration (HRSA), aims to improve access to services for Native Hawaiians living in Hawaii. The program provides funding to five Native Hawaiian Health Care Systems—each serving different islands—and an oversight body named Papa Ola Lokahi. (See the picture.)

Map of the Native Hawaiian Health Care System

The systems, which vary in size, offer a variety of health care and other services, including primary care, mental health, and wellness programs. The systems also serve as a bridge to Western medicine and integrate traditional Native Hawaiian values, beliefs, and practices. In 2022, in five systems, the number of patients with medical visits will go from 315 to 3,413, and the amount of income received will go from $3.5 to almost $9.7 million. Federal grants, which include awards to the Native Hawaiian Health Care Systems Program, are the primary source of revenue for all systems.

The HRSA awards program funds through a limited competition grant open only to five systems and Papa Ola Lokahi. According to HRSA and Papa Ola Lokahi officials, HRSA relies on recommendations from Papa Ola Lokahi to determine the amount of funding to be given to each of the systems each year. Fiscal year 2022 program funding for each system ranges from $2.8 to $3.4 million.

HRSA uses several processes to manage the program and help systems and Papa Ola Lokahi meet program requirements. This includes: annual review of operational and financial reports, in-person operational site visits once every 3 years, and monitoring calls to discuss program updates and other topics.

Why GAO Did It

The estimated 328,000 Native Hawaiians living in the state of Hawaii in 2022 face significant health disparities compared to other state populations. The Native Hawaiian Health Care Systems Program, administered by HRSA, aims to improve Native Hawaiians’ access to disease prevention, health promotion, and primary care services in Hawaii. The systems are part of Hawaii’s broader health care infrastructure, which includes other medical service providers from which Native Hawaiians can seek care.

House Report 117-96 includes a provision for the GAO to review health care services available to Native Hawaiians living in Hawaii. This report describes (1) the provision of services and other characteristics of Native Hawaiian Health Care Systems; (2) how funds are provided to the Native Hawaiian Health Care Systems Program; and (3) how HRSA administers the program.

The GAO reviewed reports that the systems submitted to HRSA, which included data on services provided, patients served, and revenue received through 2022. GAO also reviewed agency documents and funding data. of the program from fiscal years 2018 to 2022 to cover at least one full (3-year) grant cycle and include the most recent fiscal year data available at the time of the review. In addition, the GAO interviewed HRSA officials and officials from each of the five systems and Papa Ola Lokahi.

For more information, contact Michelle B. Rosenberg at (202) 512-7114 or RosenbergM@gao.gov.