Craig Carter5/2/17

HS&P AHP

Dr. Wallace

Privatization of the Veterans Health Administration (VHA)

Introduction

The VHA has been in existence since 1929 with the mission, “to care for he who bore the battle, for his widow and his sons” as shared by President Abraham Lincoln in a Civil War address. For the past 88 years, the VHA has carried out this mission as a provider of healthcare to eligible Veterans. Today, the VHA is the largest integrated healthcare system in the US operating 1,233 facilities with 20,000 physicians, 288,000 employees and an annual budget of $59 billion dollars, which cares for over 9.1 million Veterans (Giroir, 2015). Historically, the VHA has purchased healthcare in the private market when demand outstrips supply and for patients in rural communities. However, a recent independent study shows that since 2002 the cost and demand for VHA purchased healthcare in the private market has multiplied by 5-6 times, from $890 million to $5.57 billion and from 334,834 Veterans to 1,251,197 Veterans, respectively (RAND, 2016). This transition saw a substantial increase at the end of summer 2014 when the VHA was at the center of public concerns regarding alleged delayed access to care, preventable deaths and falsification of wait times (Giroir, 2015, Kizer and Ashish, 2014). In response to these public concerns, Congress passed the Veterans Access, Choice, and Accountability Act (VACAA, 2014), which included an additional $10 billion dollars to spend on Veterans waiting greater than 30 days for a VHA internal appointment or living greater than 40 miles from a VHA facility that could provide the required healthcare appointment. VACAA was set to expire on 8/7/17, however Congress recently passed S.544 striking the sunset date from the legislation.

Sources

  • A fatal wait: Veterans languish and die on a VA hospital’s secret list. CNN, 2014
  • Executive summary only:Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System. VA OIG, 2014
  • Quality of Care in VA Health System Compares Well to Other Health Settings. RAND, 2016
  • Pages 9-12: Balancing Demand and Supply for Veterans’ Health Care. RAND, 2016

Questions

  1. Compare the original CNN article and the OIG’s investigative report. While there were findings and improvements required, the OIG reported, “we are unable to conclusively assert that the absence of timely quality care caused the deaths.” Why do you think the original story resulted in the termination of the Departments Secretary and an additional $10 billion towards private healthcare? This program and funding was supposed to expire after three years, why do you think it recently passed Congress unanimously to be extended indefinitely?
  2. Most published healthcare quality studies show the VHA exceeds private industry. Why is this not common knowledge? Why are we shifting funding and volume towards the private sector?
  3. A federally funded healthcare system with a set population and budget must triage healthcare and ration tax-payer’s dollars. If quality outcomes are better than private industry, but wait times for non-emergent care are longer is that acceptable?
  4. VHA is the only healthcare system of its type in the world, most other nations care for their Veterans in the private sector. With VHA’s average facility age been 60 years old and no major infrastructure investments under way, should we continue transitioning to the private sector?
  5. With the increase in the purchasing of private healthcare, 32% of VHA appointments last year were purchased by the VHA and completed in the private sector. If you were the CEO of a VHA facility, how would you decide when to use your fixed budget to provide care internally or purchase externally?

1