Hospitals Public Policy Quality Supply of Medical Services

Does the VA provide high-quality care?

This question is difficult to answer. In many countries with government provided health care, wait times are long. For the Veterans Affairs (VA) beneficiaries, this does not seem to be much of an issue according to a Penn et al. (2019) study covering wait times between 2014 and 2019:

Although wait times in the VA and PS [private sector] appeared to be similar in 2014, there have been interval improvements in VA wait times since then, while wait times in the PS appear to be static. These findings suggest that access to care within the VA has improved over time.

A study by Blay et al. (2017) found that Veterans Affairs provides high quality care as well.

Veterans Affairs hospitals had better outcomes than non-VA hospitals for 6 of 9 PSIs [patient safety indicators]. There were no significant differences for the other 3 PSIs…VA hospitals had better outcomes for all the mortality and readmissions metrics..However, on the patient experience measures, non-VA hospitals scored better overall than VA hospitals for nursing and physician communication, responsiveness, quietness, pain management, and on whether the patient would recommend the hospital to others…For behavioral health measures, non-VA hospitals did better on 4 of 9 measures, while VA hospitals did better on 1 of 9 measures.

A systematic literature review by O’Hanlon et al. (2017) found that the VA does appear to deliver high-quality care according to many studies.

The VA often (but not always) performs better than or similarly to other systems of care with regard to the safety and effectiveness of care. Additional studies of quality of care in the VA are needed on all aspects of quality, but particularly with regard to timeliness, equity, efficiency, and patient-centeredness.

Stories of low-quality care, however, do exist. Consider just a few days ago a news story appeared in the N.Y. Daily News on the care received by one veteran:

…[the patient said that VA] doctors could not identify the cause of the fainting spells and he crashed onto sidewalks 18 times, injuring his eye, face, hands and knees. He said questions about the possibility of a relationship between his heart condition and fainting were ignored…After three years of struggling with the hospital, the veteran said he went to a private doctor, who gave him an electrocardiogram and determined that his heart condition, which resulted from the attack, could be treated with a drug called Flecanide Acetate. It was prescribed on March 11, 2017, and quickly eliminated the fainting problem, he said.

How do we interpret these findings. Does the VA provide high quality care, with a few outlier low-quality outlier cases? Is the VA better at providing high-quality care or is it just better at recording quality metrics? Or does the VA–more so than the private sector–focus on providing high-quality care on public-reported measures and provide lower-quality care on unreported aspects of quality? The answer to these questions is difficult to know, but more research is needed.

1 Comment

  1. The VA health system is a mess. The government needs to acknowledge the freestanding ED model and allow them to take government insurance such as Tri-Care and Medicaid. Most freestanding EDs, such as Houston Heights Emergency Room have little to no wait time and that effeciency could mean a world of difference to the average VA patient. But the GOV has tied the hands of these ERs.

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