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The VHA is the integrated health system providing healthcare to US military veterans managed by the Department of Veteran Affairs. It is currently regarded by by some other health systems as a model to learn from (see here for a recent report about how the UK's NHS could learn how to implement integrated electronic health records effectively, something it has spent a lot of money on without producing useful results).

Philip Longman's book Best Care Anywhere argues that the VHA offers its members some of the highest quality care available anywhere in the US while doing so within a very frugal budget. To quote from the Amazon summary (my emphasis):

This important book describes the turnaround of the VA health-care system—now widely recognized as leading the nation in terms of both quality and costs—and offers insights that will be useful to patients and policymakers alike.

Better quality and cheaper care: is this true?

Update

In a recent (2018) article on infighting among Trump officials running the VHA, The Economist reports an explanation of why many Americans find it so hard to believe the VHA does a good job (counter to the widespread belief in the USA that "socialised" medicine is always bad). My emphasis:

For many Americans, the phrase “veterans’ health care” conjures images of scandal and ineptitude. Much of this is because of a crisis in 2014, when it was discovered that hospital officials had falsified records to avoid reporting delays in appointments. Heads rolled when it appeared that 40 ex-servicemen had died while waiting for appointments. Less coverage was given to later investigations, which have been largely unable to blame the deaths on the extended waiting times.

But the reality is different:

Most Americans would be shocked to learn that the VA health system actually seems to provide higher-quality care than its competitors. A review by the RAND Corporation showed that the VA outperformed non-VA care on 45 of 47 outpatient quality measures. More than 80% of new primary care patients are able to get an appointment within two weeks. Annual surveys show satisfaction levels with treatment close to 80%. In-patient care was more mixed, however, and performance tends to vary greatly between hospitals. Clearly the system needs fixing, but fundamentally broken it does not appear to be.

matt_black
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  • Two things, one you might want to mention that the VHA is part of the [Department of Veterans Affairs](http://www2.va.gov/directory/guide/division_flsh.asp?dnum=1) (VA) so this comes up in searches easier. Second, what are we defining better quality care as? – rjzii Mar 15 '13 at 18:57
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    @RobZ No single metric captures all the elements of quality, but I'd expect that looking at Outcomes, patient satisfaction, medical error rates and other related issues might give some good pointers. – matt_black Mar 15 '13 at 21:20
  • Wow, is that a politically motivated down vote? I'm not sure which aspect of the question is badly posed, ambiguous or whether I've just touched a nerve. But a downvote already *and with no reason at all* seems a little harsh. – matt_black Mar 15 '13 at 21:22
  • One thing that MUST be considered when looking at this is that VA is effectively subsidized by the rest of Health Care system - it is able to get cheaper service or drugs or devices, but that is largely made possible by other buyers getting the same products more expensively, allowing the provides of said products to make enough profit to be interested in providing it. – user5341 Mar 16 '13 at 00:48
  • ... If you remove those private buyers from the system, and use the unified health care system to drive down 100% of prices, you strongly risk either commoditizing some of what the health care system purchases, or even worse, driving providers out of business by loweiring the total margins below acceptable levels where investors are willing to own the business. – user5341 Mar 16 '13 at 00:49
  • Another factor that rarely gets considered (I am not claiming it's true, but it should be considered) is that the patients in VA system tend to be more health conscious and barring combat injuries, lead significantly healthier life than an average overweight underexcercised American health care consumer. This is ESPECIALLY felt at the later stage in life (fit healthy elderly tend to be dramatically healthier as the age progresses) and the medical care for the elderly is what comprises MOST of health care system's costs. – user5341 Mar 16 '13 at 00:51
  • Mind you, these factors would have less effect on the quality of care, but would definitely have effect on the cost of it and thus the budget. – user5341 Mar 16 '13 at 00:54
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    It's highly contentious to say VHA is 'subsidized' by the rest of the system. VHA gets a good deal on drugs and services, but that's just because its a big purchaser. Pure free market economics. Nothing to do with subsidy. – DJClayworth Mar 16 '13 at 03:21
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    @DVK It is true that some US drug companies, for example, argue that the VHA (and most European health systems for that matter) are *subsidised* by the high prices in the US free market. But it could equally be argued that the "free market" US system has protected industry against competitive pressures allowing them to price gouge their customers to an extraordinary degree. Given that most spend more on marketing than R&D I don't think the argument they would stop developing or selling products if prices were lower is a strong one. – matt_black Mar 16 '13 at 12:29
  • @matt_black - then why are there so many more R&D (not generic) drug companies in USA compared to Europe, never mind the rest of the world? – user5341 Mar 16 '13 at 12:38
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    @DVK If I could price gouge customers as much as US drug companies do and without the sorts of consumer protection provided in Europe, I'd move to the US. OTOH Europe has quite a few big drug companies, so it can't be that bad. Besides, the issue is not which market is attractive, but whether lower prices would force some firms out of business which is stretching credibility given the current profit margins. Drug firms are still *very* profitable at European prices so arguing that those prices lower innovation because firms can't make money is ridiculous. – matt_black Mar 16 '13 at 13:17
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    @dvk In response to your comment about the relative healthiness of VHA patients. Two facts: one, they are a much less healthy demographic than the average US population; two, if they are health-conscious that *could* be because of how the VHA encourages their patients to behave (so a *consequence* of VHA actions not and external explanation of why their results look good). I'd like to see some analysis of these factors in an answer. – matt_black Mar 16 '13 at 13:22
  • @matt_black - I would expect ex-military to be health-conscious BEFORE they have to deal with VA. – user5341 Mar 16 '13 at 14:07
  • @DVK Maybe, but we should look for *evidence* one way or the other rather than speculating. – matt_black Mar 16 '13 at 14:31
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    @matt_black - definitely. My comment was in the same vein as what you stated - guideline of which factors a good answer should examine (e.g. if they are excluded, it's not a good answer) – user5341 Mar 16 '13 at 14:37
  • I apologize I cannot comment (I haven't got enough points yet) but I have to share this link containing facts about the US veterans and active soldiers and the ways they are being "treated". It refers mostly to prescription medication. I hope it's somewhat relevant to your question. > [25 disturbing facts - US soldiers/veterans](http://www.naturalnews.com/039473_psychiatric_drugs_soldiers_suicides.html) The link also contains sources for all the information presented. – Radu Miron Mar 18 '13 at 09:46
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    its a bit dated now, so maybe its changed, but six years ago most VA hospitals were terrible places. http://www.washingtonpost.com/wp-dyn/content/article/2007/03/04/AR2007030401394.html – Ryathal Mar 18 '13 at 12:29
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    @Ryathal The topic of that Washington Post article is Walter Read Army Hospital. This is run by the Department of Defense not by the Veterans Health Administration. – matt_black Mar 18 '13 at 17:22

1 Answers1

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Here is wiki's summary of recent investigations. RAND's is the only one with positive findings.

Here is the RAND's press release. It does have some positive info, but also states that:

However, waiting times are highly variable by location and type of care and some veterans in some facilities face very long wait times, such as almost 40 days for a primary care appointment at the extreme. In addition, surveys show that VA patients are less likely than private-sector patients to get appointments, care and information as soon as needed.

Reports are linked here. I do not have time to read them, but it is important to check if their comparison is to treatment & outcomes from non-VA hospitals for veterans alone, or for general public. I suspect that compared to a typical US patient, veterans are more likely to comply with doctor's orders, are more fit, and less likely to "complain" in surveys.

Brythan
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Bald Bear
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    There are several problems with your answer. One is that your summary of the RAND results is heavily biased, quoting the negative and reducing the positive to "does have some positive info". And you dismiss some reports because you don't have time to read them but then speculate that their comparisons might be invalid on speculative grounds you suggest without any actual supporting evidence. This isn't a fair summary of even the evidence you link to. – matt_black Mar 05 '18 at 14:58