VA Health Care

In response to concerns that budgetary pressures and reorganization at the Department of Veterans Affairs (VA) might make specialized programs and services for disabled veterans vulnerable to cost cutting, the Veterans Health Care Eligibility Reform Act of 1996 requires VA to ensure that its capacity to provide specialized treatment and rehabilitative services is not reduced below its October 1996 capacity and to provide veterans with reasonable access to such care and services. This testimony discusses whether VA (1) is maintaining capacity with reasonable access to specialized care and (2) has data that is reliable enough to monitor and report on compliance.

GAO noted that: (1) its work to date suggests that much more information and analyses are needed to support VA's conclusion that it is maintaining its national capacity to treat special disability groups; (2) for example, while VA's data indicate that from fiscal year (FY) 1996 to FY 1997, the number of veterans served increased by 6,000, the data also show that spending for specialized disability programs decreased by $52 million; (3) VA attributes the decreased spending to reducing unnecessary duplicative services and replacing more expensive hospital inpatient treatment with outpatient care; (4) such aggregate data and assertions may, however, mask potential adverse effects on specific programs and locations; (5) for example, VA data also show that the number of veterans treated systemwide in FY 1997 decreased for amputees, and expenditures were reduced for veterans with amputations, serious mental illness, and post-traumatic stress disorder; (6) in addition, for substance abuse patients with serious mental illness, VA data show that about 3,000 fewer veterans were served and $112 million less was spent; (7) consistent with the Government Performance and Results Act of 1993, VA plans to develop outcome measures over the next 2 to 3 years to track whether, among other things, the care provided to disabled veterans is effective as a result of its shift from inpatient to outpatient care; (8) VA intends to replace expenditure data with outcome measures when they become available; (9) while outcome measures are a valuable tool to evaluate program effectiveness and to help monitor physical, psychological, and social services, retaining current measures, such as dollars spent serving VA's special needs population, are also important to measure legislative compliance; (10) beyond the issue of how VA chooses to measure its capacity to serve veterans with special disabilities, there are also questions regarding the reliability of VA's data; (11) for example, in 1998, VA reduced its reported 1996 baseline expenditure data in all six specialized programs and services by as much as 50 percent without explaining in its report the basis for such changes; (12) VA's two advisory committees have also raised questions about anomalies in the capacity data; and (13) VA has acknowledged the need to improve its data systems and has several efforts under way to do so.