Public Policy Supply of Medical Services

Is more choice for veterans a good thing?

How is President Trump planning to keep his campaign promise to improve health care for Veterans? One pathways is through his VA Mission Act of 2018. As the Washington Post reports, this bill would include $55 billion in additional funding for veterans. A key part of this legislation is that it allows for more veterans to be seen by physicians outside of the VA system.

It would require the agency to allow a veteran to see a private doctor if they agree with their VA physician that it’s in their best interest. A number of factors would be taken into account, including if the veteran lives far from a VA hospital, if the wait for an appointment is too long and if the care at the closest VA hospital is “deficient” compared with other private and VA medical offices. The veteran could appeal if the request was rejected.

Your reaction to this provision likely depends on your perception of the quality of care the VA provides. Some may say that the VA offers good care coordination, integrated electronic health records, and systematically identifies high value care. Others may cite the long wait times and difficulty accessing care. For the former, more choice chips away at the advantages of integrated care since it is difficult to access care information outside the VA system and the band for the buck may be lower outside the VA system. For the latter, more choice and competition is a good thing as it gives veterans the option if getting care elsewhere if the quality or timeliness of the care they are receiving is not up to par.

The legislation has other provisions–such as the expansion of the VA’s caregiver program, but the act will largely be judged on whether you believe that more privatization is a good or bad idea.

The VA is not the only public health care system considering increased privatization. In England, the National Health Service (NHS) has for decades debated the pros and cons of more privatization. Some of the pros (more choice, more access to innovation, market-based pricing) and cons (less egalitarian, higher administrative costs, less incentives for long-term health investment) are well known but succinctly described in an article in The Week.

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