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Should VA hospitals be privatized allowing competition and possibly better care?

Yes35 %35 %35 % 35.59 % (42)
No55 %55 %55 % 55.08 % (65)
I do not know8 %8 %8 % 8.47 % (10)
I have no opinion0 %0 %0 % 0.85 % (1)
Other, please list in comments0 %0 %0 % 0.00 % (0)

Total votes: 118
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Re: Should VA hospitals be privatized allowing competition a
by Anonymous
on Feb 23, 2005
Veterans should be given an HMO card equal to the best available. We should be able to see the best doctors we can, at an office or hospital close by, being treaded as first class citizens. At one point I received a single day, experimental drug for cancer. The bill was well over $13,000, my co-pay was $5.00. Two years later the local VA was still not using this drug. It?s nice to be alive.

Stay healthy,
Andy

Re: Should VA hospitals be privatized allowing competition a
by SEATJERKER
on Feb 25, 2005

From what I've seen at two major VA hospitals, one in Houston, the other in San Antonio, I'd rather be treated at a roadside clinic in Mexico. As with all governmental agencies, there is no incentive todo exceptional work, and therefore mediocrity prevails. I believe that veterans deserve more than just mediocre treatment.


Re: Should VA hospitals be privatized allowing competition a
by Gimpy
on Feb 25, 2005
Give all qualified vets a card. Let them choose their own doctors and treatment. Andy has a great idea. It would keep most of the buracy out of it. The government wouldn't be managing medicine or maintaining large facilities, it would multiple millions each year.

Keith_Hixson

Re: Should VA hospitals be privatized allowing competition a
by
on Mar 02, 2005
The improvements in VA health care during the past 10 years are evident and compelling as this new study reports. It would be WRONG to attempt to "privatize" a system that the private sector is drastically inadequate to handle!!

###########

December 20, 2004

Study Finds VA Health Care Improving

MONDAY, Dec. 20 (HealthDayNews)

-- A new study finds that patients who use the Department of Veterans Affairs health system get better preventive care, particularly for chronic conditions, than patients in the private sector.

VA patients receive at least two-thirds of recommended care, while those using private health care get only about half, the researchers said.

The difference between VA and private care was most striking in areas where the VA had established performance requirements and actively monitored them, according to the report in the Dec. 21 issue of the Annals of Internal Medicine. The VA co-sponsored the study.

In the past, the agency had been criticized for delivering poor care, but "this is not your father's VA," said lead researcher Dr. Steven M. Asch, a physician at the VA Greater Los Angeles Health Care System and an associate professor of medicine at UCLA. "They have undergone a quality transformation in the last 10 years."

"The VA has built an information superhighway for medical care information," Asch said. "And they hold managers and providers responsible for getting good results. The VA has the systems in place to make sure the right things get done."

They found that, overall, VA patients received 67 percent of recommended care, compared with 51 percent of private sector patients. In addition, VA patients with chronic conditions received recommended care 72 percent of the time, while similar patients in the private sector got it 59 percent of the time.

Sixty-four percent of VA patients got such preventive measures as pneumococcal vaccination and colorectal cancer screening, compared with 44 percent of private sector patients.

Asch's team found VA patients got better care across the board, including screening, diagnosis, treatment and follow-up. When it came to acute care, the VA and private health care were equal, the researchers report.

"This study demonstrates for the first time the lift that we get in quality of care by having electronic medical markers put together with performance measures and tools that make people accountable," said co-author Elizabeth A. McGlynn, the associate director of Rand Health, a nonprofit group that worked with VA doctors on the study.

McGlynn added that other studies have shown that improving the quality of care leads to improved patient outcomes.

The VA is continuing its quality improvement program, Asch said. He believes that many of the lessons learned at the VA can be transferred to private health care.

However, there are problems in getting private health care to go along with these changes. Among these are cost, he said.
"Our health-care system isn't really a system," Asch said. "There's nobody in charge." Given that, it is difficult to get the health-care system moving in one direction.

Asch believes the government's role is to set standards to create a better flow of quality care information.

"It is possible to improve care patients receive," Asch continued. "We don't have to settle for what we are seeing in the rest of the country. The kind of the things the VA is doing are the kind of things the rest of the system should emulate to improve care."

"This finding is not surprising," said Dr. David U. Himmelstein, an associate professor of medicine at Harvard Medical School. "Most of us have been aware that the VA has the most vigorous quality improvement program over the last decade."

Himmelstein said that what the VA has done in improving the quality of the care it delivers is a lesson for private health care. "It gives the lie to the perception that the government is slow and behind the times in health care," he said.
"When we talk about national health insurance, people often say: 'Do you want a program that has the responsiveness of the Post Office, the heart of the IRS, and the efficiency of the Pentagon?' Yet it does look like the VA health-care system runs better than the private sector," Himmelstein said.

Himmelstein opined that the study highlights how bad private health care is. "When we move toward privatizing Medicare, we're headed toward deep trouble. We're headed toward a system which is very likely to be lower quality than the government run-system we have now," he said.

Himmelstein believes private health care is reluctant to introduce quality improvement because there is no money in it. "Image is everything," he said. "The reality of improving quality is probably more expensive than the investment warrants. We have a health-care system which is ruled by the market, and the market is a lousy tool to implement quality."

#########


Re: Should VA hospitals be privatized allowing competition a
by
on Mar 05, 2005
More evidence to support claims that VA health care for veterans is now and will continue to be better than what the "private sector" could offer....

##########

The VA Health CareSystem: An Unrecognized National Safety Net

Veterans who use the VA health care system have a higher level of illness than the general population, and 60 percent have no private or Medigap insurance.

ABSTRACT: The dominance of local health care markets in conjunction with variable public funding results in a national patchwork of "safety nets" and beneficiaries in the United States rather than a uniform system. This DataWatch describes how the recently reorganized Department of Veterans Affairs serves as a coordinated, national safety-net provider and characterizes the veterans who are not supported by the market-based system.
The role of Department of Veterans Affairs (VA) as a health care safety net is largely unrecognized.

Many think of VA medical care as a benefit awarded only to veterans who are ?service-connected??that is, veterans who are disabled by illness or injury in the line of duty during military service. However, 60 percent of veterans who received VA medical care in 1992 had no private or Medigap insurance and would likely be considered the responsibility of the health care safety net.

Unfortunately, the availability of federal, state, and local government funds to subsidize the care of persons left without services varies by state and community and may not match community need. The result is a national patchwork of safety nets and beneficiaries health care system stands out as a significant, coordinated, nationwide safety net for veterans.

VA Service Networks

Organization

The VA health care system recently reorganized into twenty-two Veterans Integrated Service Networks (VISNs) on the basis of geographic referral patterns to maximize patients? access to care while improving efficiencies in service delivery.

Appropriated funds are distributed according to the VA?s new Veterans Equitable Resource Allocation capitation model that bases network funding on the volume of service-connected and low-income veterans served. Low income is defined as less than $21,610 a year for a single veteran. VISNs offer a full continuum of care to patients within their boundaries through direct delivery or contractual agreements with other networks or providers.

A typical network consists of six to ten hospitals that provide acute inpatient medical and surgical, psychiatric, and substance abuse services, along with subacute and rehabilitation services. Each network also manages twenty to thirty freestanding outpatient clinics, nine to ten readjustment counseling centers, six to eight home-based primary care programs, five to seven VA nursing homes, one or more residential housing facilities (domiciliaries), and contracts with 140?150 community nursing homes and several state veterans? homes.

Performance measurement

VA headquarters manages the twenty-two networks by setting goals and designing strategies to maximize health care value throughout the nation. Value is defined as balanced performance of five factors: cost, access, technical quality, patient functional ability, and patient satisfaction. Headquarters focuses on developing a standardized measurement and monitoring system that supports risk-adjusted comparative analyses among networks.

Networks are held accountable for results through a newly implemented performance contract system that rewards excellent performance on clinical as well as cost outcomes. These efforts are designed to assure that high-quality care is consistently delivered by VA providers nationwide.

Veterans? Health Status And Special Care Needs
The core mission of the VA is to provide primary care, specialized care, and related medical and social support services to veterans. The VA health care system is a safety net because many of the veterans served are psychologically and economically disadvantaged and have a high disease burden (Exhibits 1 and 2).Veterans? average scores on the Short Form 36-Item Health Survey for Veterans (SF-36V) are significantly worse (lower) than those for either the general population or the Medical Outcomes Study population (Exhibit 3). Having scores at least ten points lower on either the physical or mental component scales has been shown to be equivalent to having approximately two additional chronic conditions, 30 percent more hospitalizations, and 20 percent more outpatient visits. Comorbidity from psychiatric illness is common among VA health care users (Exhibit 4) and requires 14 percent of the VA?s total $17 billion medical care budget. In addition, on a given day in 1996, homeless patients accounted for 13.5 percent of all admissions, 24 percent of general psychiatry admissions, and 47 percent of substance abuse admissions.

EXHIBIT 1
Characteristics Of Veteran VA Health Care Users And Nonusers Compared With The General Population


Veteran Veteran General
Characteristic VA user non-VA user population

Age 65 and older 35.6% 31.3% 17.0%
Non-Caucasian 25.4 12.5 22.8
Not married 35.7 19.4 39.0
Education less than high school 26.0 15.0 24.8
Income less than $20,000 70.5 25.7 32.9
Income less than $10,000 38.5 8.7 14.6

No private or Medigap insurance 59.3 14.9 32.0
No health care coverage 21.0 5.2 17.0
Poor or fair perceived health status 60.5 25.4 11.3
Unable to work for pay/limited ADLs 79.4 40.1 7.0

SOURCE: 1992 National Survey of Veterans (Washington: Department of Veterans Affairs, 1994); and 1996 Medical Expenditure Panel Survey (Rockville, Md.: Agency for Health Care Policy and Research, 1996).

NOTES: VA is Veterans Affairs. ADLs are activities of daily living.

EXHIBIT 2
Disease Prevalence Among VA Health Care Users, 1996


Disease Prevalence

Ischemic heart disease 50%
Obesity 50
Hypertension 45
Smoking 34
Psychiatric illness 23
Diabetes mellitus 19
COPD 15
Substance abuse 9
SOURCE: VA National Patient Care Database.
NOTES: VA is Veterans Affairs. COPD is chronic obstructive pulmonary disease.

EXHIBIT 3
Health Status Of Veteran VA Health Care Users Compared With Medical Outcomes Study (MOS) Population And General U.S. Population, As Measured By SF-36V


VA MOs General U.S.
(n = 32,960) (n = 22,462) (n = 2,474)

Physical component summary score 31 44 50
Mental component summary score 41 52 50
SOURCE: N.J. Wilson and L. Kazis, ?Health Status of Veterans: Physical and Mental Component Summary Scores (SF-36V),? 1996 National Survey of Ambulatory Care Patients Executive Report (Washington: Department of Veterans Affairs, February 1997).

NOTES: VA is Veterans Affairs. SF-36V is Short Form 36-Item Health Survey for Veterans.

EXHIBIT 4
VA Psychiatric And Substance Abuse Inpatient And Outpatient Workload, 1996


Inpatient Inpatient
acute care hospital long-term care

Service Outpatient
Episodes Bed days Episodes Bed days visits

Psychiatry 149,550 8,308,876 722 62,836 6,445,707
(13.2%) (39.1%) (1.2%) (0.3%) (21.4%)
Substance abuse 61,099 1,039,069 5,073 488,720 1,709,626
(5.4%) (4.9%) (8.7%) (2.0%) (5.7%)
All other 925,537 11,887,892 52,836 23,433,316 21,899,379
(81.5%) (56.0%) (90.0%) (97.7%) (72.9%)

Total 1,136,186 21,235,837 58,631 23,984,872 30,054,712
SOURCE: VA National Patient Care Database.
NOTE: VA is Veterans Affairs.

The VA also cares for small vulnerable populations for whom care is expensive but generally unprofitable in the private sector, in part because of the absence of economies of scale (Exhibit 5). The VA?s capacity to provide this care is based on the occurrence of many of these conditions during, or as a consequence of, military service. Recently enacted veterans? health care eligibility reform legislation has reinforced the VA?s continued role as a safety-net provider for these populations. In addition to veterans with service-connected illnesses, injuries, and exposures and former prisoners of war, the VA is legislated to treat veterans with special disabilities of spinal cord dysfunction, blindness, amputation, traumatic brain injury, catastrophic disability, post-traumatic stress disorder, and serious mental illness, including substance abuse and homelessness resulting from mental illness. Low-income veterans without any of the above disabilities will be cared for to the extent that funding allows.

EXHIBIT 5
VA Care For Small Vulnerable Populations, 1996


Disability Persons Bed days Clinic visits Dollars

Spinal cord dysfunction 21,145 671,391 644,419 $556,515,255
Blindness 22,392 209,228 739,185 326,564,928
Traumatic brain injury 1,925 83,240 81,516 47,686,100
Amputation 7,573 313,432 301,183 286,350,276

SOURCE: VA National Patient Care Database.
NOTE: VA is Veterans Affairs.

Conclusion

As long as local market forces dominate the health care industry and state and local funding vary, the stabilizing influence of a national safety net like the VA health care system becomes ever more important. The VA, in the midst of its own transformation, serves part of that role by providing comprehensive services to approximately 1.7 million veterans (and with more enrolling every day) who are not well supported by a market- based system.

Also, as long as the patchwork of safety nets remains, fluctuations in the availability of one system will cause repercussions for others. Significant changes in the VA?s safety-net function would be felt in every corner of the nation, in that any decrease in the VA?s ability to care for veterans would most likely fall to Medicare, Medicaid, or other publicly funded programs.

The converse is also true. Society has made an investment in a medical care system for veterans in recognition of the continuing cost of war and national security and the special contributions that veterans have made to the nation. The VA?s role as a national health care safety net provides an additional social benefit that is often overlooked. This role should be more widely recognized.

Veterans are increasingly satisfied by changes in the VA health system. On the American Customer Satisfaction Index,20 the VA bested the private sector's mean healthcare score of 68 on a 100-point scale, with scores of 80 for ambulatory care, 81 for inpatient care, and 83 for pharmacy services for the past 3 years. Similar improvements have been achieved in each value domain.

It also is worth emphasizing that since 1996, improved outcomes have been achieved in each of the value domains, while simultaneously reducing the cost per patient by more than 25%. Returning to the value equation, it would seem evident that the numerator (outputs) rose while the denominator (resource inputs) dropped, signifying enhanced value.

NOTES
1. 1992 National Survey of Veterans (Washington: Department of Veterans Affairs, 1994).

2. K.W. Kizer, Vision for Change: A Plan to Restructure the Veterans Health Administration (Washington: Department of Veterans Affairs, 1995); K.W. Kizer, ?The Changing Face of the Veterans Affairs Health Care System,? Minnesota Medicine (February 1997): 24?28; and K.W. Kizer, ?Transforming the Veterans Health Care System: The ?New VA?,? Journal of the American Medical Association 275, no. 14 (1996): 1069.

3. Veterans Equitable Resource Allocation System Briefing Booklet (Washington: Department of Veterans Affairs, March 1997).

4. ?New Means Test Thresholds?1997,? VHA Directive 96-076 (20 December 1996).

5. Kizer, Vision for Change.

6. K.W. Kizer, Prescription for Change: The Guiding Principles and Strategic Objectives Underlying the Transformation of the Veterans Healthcare System (Washington: Department of Veterans Affairs, 1996).

7. J. Sunshine, interview with N.J. Wilson, ?A New Approach to Quality in VA,? Federal Practitioner (Part 1) (May 1996): 59?60, and (Part 2) (June 1996): 56?57.

8. N.J. Wilson, ?VA Performance Agreements: Changing VA Performance,? SGIM Newsletter (May 1997).

9. S. Isaacson et al., Substance Abuse Treatment: VA Programs Serve Psychologically and Economically Disadvantaged Veterans, GAO/HEHS-97-6/B-271298 (Washington: U.S. General Accounting Office, 5 November 1996).

10. N.J. Wilson and L. Kazis, ?Health Status of Veterans: Physical and Mental Component Summary Scores (SF-36V),? 1996 National Survey of Ambulatory Care Patients Executive Report (Washington: Department of Veterans Affairs, February 1997).

11. Office of the Assistant Secretary for Management, FY 1998 Budget Submission (Washington: Department of Veterans Affairs, February 1997).
12. R. Rosenheck, C. Leda, and D. Siessert, FY 1996 End-of-Year Survey of Homeless Veterans in VA Inpatient Care Programs (West Haven, Conn.: N.E. Program Evaluation Center, forthcoming).

13. The Veterans Health Care Eligibility Reform Act of 1996, Public Law 104-262 (March 1997).





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