Looking to Veterans’ Health Care Model
The Affordable Care Act's (ACA) passage does not signal the health care debate's end. Rather, it's the end of one phase and the beginning of another. The ACA's most substantial reforms dealt with questions of access by expanding insurance. At the same time, it invests in a series of pilot programs to jump start the conversation on how to improve the quality of care. One model that can offer insight into improving the quality of care is the Veterans Health Administration.
It may surprise you to find out that our veterans receive some of the best care in the nation. Many people falsely associate the horror stories of places like Walter Reed Army Hospital with the VHA. But Walter Reed is not part of the VHA; it is run by the army. This, and the VHA past history, have colored the general population’s perceptions of the VHA. But the reality of the current situation is overwhelming positive.
In a 2004 study by the RAND Corporation which compared the quality of care in the VHA system with the quality of care in the rest of the country shows that the VHA is ahead in nearly every quality measure. RAND attributes this to two factors. The first is the utilization of technology, which allows for better coordinated care and reduced medical errors. The other was the VHA’s performance measurement system.
The VHA keeps meticulous records and is constantly trying to hit certain performance goals. According to the RAND study, “… performance measurement has a “spillover effect” that influences care: VA patients were more likely than patients in the national sample to receive recommended care for conditions related to those on which performance is measured. … This provides strong evidence that, if one tracks quality, it will improve not only in the area tracked but overall as well.”
The VHA is also better at controlling costs. According to a CBO report, “Adjusting for the changing mix of patients (using data on reliance and relative costs by priority group), the … (CBO) estimates that VHA’s budget authority per enrollee grew by 1.7 percent in real terms from 1999 to 2005 … that estimate still indicates some degree of cost control when compared with Medicare’s real rate of growth of 29.4 percent in cost per capita over that same period ....”
While no system is absolutely perfect, the VHA system is vastly superior to our current one. When the next phase in the health care debate begins again, we would be better off if we look to the VHA for guidance.