VA Health Care

In recent years, the Department of Veterans Affairs (VA) has launched two major initiatives to change the way it manages its $17 billion health care system. In fiscal year 1996, VA decentralized the management structure of its Veterans Health Administration, forming 22 veterans integrated service networks to coordinate the activities of hundreds of hospitals, outpatient clinics, nursing homes, and other facilities. VA expected the networks to improve efficiency and patient access. In April 1997, VA began to phase in the veterans equitable resource allocation system to distribute resources to the 22 networks. Previously, each medical center received and managed its own budget. Concerned that some networks would be forced to take significant cost-saving measures to manage with the diminished resources they would receive under the veterans equitable resource allocation system and that these networks would, as a result, reduce veterans' access to care, Congress asked GAO to examine changes in access to care in two networks--one headquartered in Bronx, New York, and one headquartered in Pittsburgh, Pennsylvania. This report discusses (1) the changes in overall access to care, changes in access to certain specialized services, and a comparison of changes in these networks with VA's national data from fiscal years 1995 to 1997; (2) the extent to which VA headquarters and networks are working to equitably allocate resources to facilities within the networks; and (3) the adequacy of VA's oversight of changes in access to care.

GAO noted that: (1) overall, VISN 3, VISN 4, and VA nationally have increased access as measured by increases in the number of veterans served; (2) access to care, as measured by patient satisfaction, also seems to have improved according to responses to VA surveys and interviews GAO conducted; (3) in addition, VA has improved geographic access to primary care by increasing the number of community-based clinics in these two VISNs; (4) although access has increased overall, access appears to have decreased for some specific services; (5) the two VISNs GAO reviewed used no specific criteria for allocating their resources to reduce historical access inequities among their facilities; (6) VA headquarters neither provides criteria for VISNs to use to equitably allocate resources nor reviews the allocations for equity; (7) although VA has made progress in improving the equity of resource allocations nationwide among the networks, it has done little to ensure that the networks fulfill the Veterans Equitable Resource Allocation (VERA) system's promise as they allocate resources to their facilities; (8) although GAO prepared an overall assessment of access to care, difficulties in working with the data cast doubt on whether VA can perform timely and effective oversight; (9) the information GAO developed on changes in access to care at the facility and network levels for VISN 3 and VISN 4, as well as for VA nationally, was gathered from many VA reports and databases--some of which had inconsistent or incompatible information that GAO was able to resolve; (10) moreover, medical center, VISN, and headquarters officials told GAO that such data are not available on a routine, timely basis; (11) without such information, it is difficult for them to say conclusively whether VA has improved veterans' equity of access to care and whether veterans have not been adversely affected by the many changes under way to reduce costs and improve productivity; (12) by taking several actions, VA could improve its oversight of changes in access to care and its resource allocation process; and (13) these actions include improving data collection and dissemination efforts regarding changes in access to care and establishing criteria for VISNs to use for more equitably allocating resources to their 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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