VA Health Care

Variabilities in Outpatient Care Eligibility and Rationing Decisions Gao ID: HRD-93-106 July 16, 1993

Veterans' access to outpatient care at Department of Veterans Affairs (VA) medical centers varies widely. The reasons are twofold: first, medical centers throughout the country interpret VA outpatient eligibility criteria differently; and second, medical centers' rationing decisions vary, including whether to ration and what rationing method to use. This means that veterans with similar medical conditions or income status may receive outpatient care at some medical centers but not at others. As a result, veterans are often confused or frustrated when turned away by VA centers without receiving needed medical care. GAO recommends that VA develop alternative eligibility criteria that produce more predictable eligibility decisions or provide better guidance to centers so that doctors make more consistent eligibility determinations. In addition, Congress may want to direct VA to modify its system for allocating resources to medical centers so that veterans with similar medical or economic status have more consistent access to outpatient care. GAO summarized this report, along with GAO/HRD-93-123, in testimony before Congress; see: Veterans Affairs: Accessibility of Outpatient Care at VA Medical Centers, by David P. Baine, Director of Federal Health Care Delivery Issues, before the Subcommittee on Oversight and Investigations, House Committee on Veterans' Affairs. GAO/T-HRD-93-29, July 21, 1993 (11 pages).

GAO found that: (1) veterans' access to outpatient care at VA medical centers varies because medical centers interpret VA eligibility criteria differently and make rationing decisions on an individual basis; (2) the need for hospitalization is difficult to determine, since interpretations of statutory outpatient eligibility criteria depend upon physicians' subjective judgments; (3) 118 VA medical centers rationed veterans' discretionary outpatient care in 1991 to varying degrees; and (4) the VA medical centers that ration care make their rationing decisions based on income levels, medical service, and the type of medical condition, resulting in veterans with similar medical conditions receiving different levels of care.


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