VA Health Care

The Department of Veterans Affairs (VA) has requested $211 million for a hospital construction project at Travis Air Force Base in California. The project would provide additional hospital beds for veterans who were previously served by a VA hospital in Martinez, California, that closed in 1991 because of concerns about earthquake safety. GAO concludes that the additional hospital beds and outpatient clinic VA has proposed for Travis are unnecessary. Today, more than 3,300 hospital beds in northern California are going unused, including beds in VA, Air Force, and community hospitals. In addition, the VA population is expected to drop by about 25 percent between 1995 and 2010. Further, VA has not considered the likely negative effects the additional beds could have on other hospitals in northern California, particularly community hospitals in the Solano County areas surrounding Travis that have occupancy rates of about 40 percent. Several more efficient alternatives are available to VA in the event that demand for hospital care increases. For example, existing clinic's hospital referral patterns could be changed to manage excess capacity in existing VA and Defense Department hospitals. Similarly, VA clinics should be able to purchase care from community hospitals more conveniently and at a lower cost than would be incurred through the construction of additional beds. Legislation to expand VA's contracting authority is pending in Congress. Finally, with the planned closure of the Mather hospital, VA has an opportunity to acquire a fully functional facility for use as either a hospital or an outpatient clinic.

GAO found that: (1) construction of additional hospital beds and an outpatient clinic as large as VA proposes at Travis Air Force Base is unnecessary; (2) significant changes have occurred in the health care marketplace and in the way VA delivers health care in the 4 years since the project was planned, but VA plans have not been revised accordingly; (3) these changes alone have resulted in over 3,300 unused hospital beds in northern California hospitals, including beds in VA, Air Force, and community hospitals; (4) in addition, the veteran population in the service area is expected to drop by about 25 percent between 1995 and 2010; (5) VA has not considered the likely negative effects the additional beds could have on other hospitals in northern California, particularly those community hospitals in the Solano County area surrounding Travis Air Force Base that have occupancy rates of around 40 percent; (6) data GAO obtained show that VA is currently meeting the health care needs of veterans served by the Northern California Health Care System; (7) with VA hospitals at Palo Alto, San Francisco, and Travis operating below capacity, VA clinics have no trouble placing patients needing hospital care; (8) also, while VA's four clinics in the area intended to be served by the Travis hospital are operating at close to full capacity, three have turned away no veterans needing hospital or outpatient care; (9) in addition, the clinics have effectively used community hospitals for medical emergencies; (10) VA officials pointed out, and GAO's visits confirmed, that space constraints, such as the lack of sufficient numbers of examining rooms, prevent them from operating as efficiently as they could otherwise; (11) GAO identified several more efficient alternatives that are available to VA if increased demand for hospital care should materialize; (12) VA officials in the Sierra Pacific Network are currently studying the best way to meet veterans' future health care needs; and (13) network officials are considering options to make better use of VA facilities and increase the use of private and other public facilities.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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