VA Health Care

The Department of Veterans Affairs (VA) has taken important steps to improve the efficiency of its health care system and veterans' access to it. VA medical centers have increased efficiency by expanding the use of outpatient care. Preventive care, including health assessments and patient education, has also increased, enabling patients to stay healthier and avoid expensive hospital stays. VA is further increasing efficiency by integrating services both within and among medical centers. VA is improving access to health care in several ways. For example, it has begun to emphasize primary care, in which generalist physicians see patients initially and coordinate any specialty care that patients may need. In addition, VA is providing outpatient care at additional community-based outpatient clinics, expanding evening and weekend hours for clinics, and exploring other innovations. As networks and medical centers continue to respond to incentives to improve the efficiency of their operations, headquarters' monitoring of the impact of such responses is necessary to help ensure that they do not compromise the appropriateness of health care that veterans receive.

GAO noted that: (1) VA has taken important steps to improve the efficiency of its health care system and veterans' access to it; (2) VA medical centers have increased efficiency by expanding the use of outpatient care; (3) for example, VA has increased the percentage of surgical procedures performed on an outpatient basis from 34 percent in fiscal year 1993 to 66 percent by mid-fiscal year 1997; (4) this has allowed it to reduce bed-days of care, operating beds, and staff; (5) at the Pittsburgh, Pennsylvania, medical center, the increase in outpatient surgeries saved more than $7.5 million from October 1995 through May 31, 1997; (6) preventive care, including health assessments and patient education, has also increased, which VA officials told GAO can lead to efficiencies because patients can be kept healthier, avoiding expensive hospital stays; (7) furthermore, VA is increasing efficiency by integrating services both within and among medical centers; (8) VA is improving access to health care in several ways; (9) for example, VA has begun to emphasize primary care, in which generalist physicians see patients initially and coordinate any specialty care that patients may need; (10) by increasing the number of primary care teams, VA has improved access to routine care and expedited referrals to specialty care; (11) VA is also improving access to health care by providing outpatient care at additional community-based outpatient clinics, expanding evening and weekend hours for clinics, and exploring other innovations; (12) these efforts have shortened the time veterans spend waiting for an appointment as well as that spent waiting to be seen upon arrival for an appointment; (13) all of the medical centers GAO visited have established primary care teams and increased the number of veterans assigned to primary care; (14) as networks and medical centers continue to respond to incentives to improve the efficiency of their operations, headquarters' monitoring of the impact of such responses is necessary to help ensure that they do not compromise the appropriateness of health care veterans receive; and (15) GAO found that although VA has implemented health care monitoring mechanisms to assess some of the changes networks and medical centers are introducing, these mechanisms have not fully succeeded.