Veterans' Health Care

About 9,400 veterans live on Guam and the Commonwealth of the Northern Mariana Islands. On Guam alone, about 700 veterans received health care from the Department of Veterans Affairs (VA) in 1997, at a cost of $1.2 million. In addition to providing care through its outpatient clinic, VA bought care from the Navy and private providers on Guam, as well as from military and private providers in Hawaii and the continental United States. Veterans groups have raised concerns about the health care provided on Guam and the inconvenience of traveling to Hawaii and elsewhere when appropriate care is unavailable on Guam. They have also raised concerns about the possibility that the Navy may reduce or eliminate services in its hospital on Guam. They believe that VA should establish an inpatient facility at the U.S. Naval Hospital on Guam. This report (1) describes how VA now meets veterans health care needs on Guam and the Northern Mariana Islands, (2) estimates these veterans' possible future demand for health care and assesses VA's ability to meet this demand, and (3) estimates the cost to establish a veterans' inpatient ward at the U.S. Naval Hospital on Guam.

GAO noted that: (1) to meet the health care needs of veterans on Guam and CNMI, VA currently provides services through a network of providers; (2) this network includes outpatient and inpatient care provided on Guam as well as by military or private hospitals in Hawaii or the continental United States, which is accessed through aeromedical evacuations; (3) in discussing their concerns about the VA health care system, veterans on Guam told GAO that medical evacuations, while necessary, are inconvenient and that they would like the U.S. Naval Hospital on Guam to provide cardiac care to reduce the need for some of these evacuations; (4) however, VA and Naval Hospital records indicate that only 15 percent of the 1,140 medical evacuations provided to military beneficiaries and veterans over the past 3 years were for cardiac care, which, according to Department of Defense officials, is an insufficient workload to maintain quality care for this specialty; (5) in the future, VA and Navy officials expect to be able to continue to meet veterans' demand for health care; (6) VA and Navy officials told GAO that they expect to continue providing the same type of health care to Guam and CNMI veterans that is currently available, including the services provided by the U.S. Naval Hospital; (7) even if there were a significant increase in veterans' demand for inpatient medical care in the future, U.S. Naval Hospital officials believe that their hospital could handle the potential veteran inpatient workload; (8) currently, the U.S. Naval Hospital has a total capacity of 146 beds--consisting of 29 active beds and 117 inactive beds; (9) in fiscal year 1997, of the 29 active beds, military beneficiaries used 22 beds per day on average and veterans used less than 1 on average; (10) GAO's analyses indicate that, under a high-demand scenario, Guam and CNMI veterans would use, on average, 14 inpatient beds per day; (11) while it is highly unlikely that Guam and CNMI veterans' demand for inpatient health care will ever reach this level, Navy officials told GAO that the U.S. Naval Hospital could hire staff and activate additional beds, if needed, to meet this demand; (12) these officials said that apart from a large conflict or war, which they could not predict, they were confident that the U.S. Naval Hospital on Guam could handle any likely increase in veteran inpatient workload; and (13) in light of GAO's analysis, establishing an inpatient ward at the U.S. Naval Hospital is not warranted and would be expensive.