Reconsidering the Veterans Health Administration: A Model and a Moment for Publicly Funded Health Care Delivery
Authors: Joan J. Ryoo, Jennifer L. Malin
Journal: Annals of Internal Medicine (2011)

Editorials7 June 2011Reconsidering the Veterans Health Administration: A Model and a Moment for Publicly Funded Health Care DeliveryJoan J. Ryoo, MD, MSHS and Jennifer L. Malin, MD, PhDJoan J. Ryoo, MD, MSHSFrom UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095-6900, and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073.Search for more papers by this author and Jennifer L. Malin, MD, PhDFrom UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095-6900, and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-11-201106070-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Since the Veterans Health Administration (VHA) was systemically (and systematically) “reengineered” to follow a more decentralized, managed care template more than 15 years ago (1–3), it has demonstrated accumulating achievements in health and health care delivery, over time outshining not only its own performance but that of others (4–6). In chronic disease management and preventive care, the VHA has surpassed Medicare (7), commercial managed care (8), and various community health systems in adherence to broadly accepted process measures (9).Furthermore, beneficiaries of the VHA seem to have health outcomes—including mortality—that are the same as or better than those of Medicare ...References1. Kizer KW, Demakis JG, Feussner JR. Reinventing VA health care: systematizing quality improvement and quality innovation. Med Care. 2000;38:I7-16. [PMID: 10843266] CrossrefMedlineGoogle Scholar2. Greenfield S, Kaplan SH. Creating a culture of quality: the remarkable transformation of the department of Veterans Affairs Health Care System [Editorial]. Ann Intern Med. 2004;141:316-8. [PMID: 15313749] LinkGoogle Scholar3. Oliver A. The Veterans Health Administration: an American success story? Milbank Q. 2007;85:5-35. [PMID: 17319805] CrossrefMedlineGoogle Scholar4. Ashton CM, Souchek J, Petersen NJ, Menke TJ, Collins TC, Kizer KW, et al. Hospital use and survival among Veterans Affairs beneficiaries. N Engl J Med. 2003;349:1637-46. [PMID: 14573736] CrossrefMedlineGoogle Scholar5. Neugaard BI, Priest JL, Burch SP, Cantrell CR, Foulis PR. Quality of care for veterans with chronic diseases: performance on quality indicators, medication use and adherence, and health care utilization. Popul Health Manag. 2011;14:99-106. [PMID: 21091367] CrossrefMedlineGoogle Scholar6. Evans DC, Nichol WP, Perlin JB. Effect of the implementation of an enterprise-wide Electronic Health Record on productivity in the Veterans Health Administration. Health Econ Policy Law. 2006;1:163-9. [PMID: 18634688] CrossrefMedlineGoogle Scholar7. Jha AK, Perlin JB, Kizer KW, Dudley RA. Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. N Engl J Med. 2003;348:2218-27. [PMID: 12773650] CrossrefMedlineGoogle Scholar8. Kerr EA, Gerzoff RB, Krein SL, Selby JV, Piette JD, Curb JD, et al. Diabetes care quality in the Veterans Affairs Health Care System and commercial managed care: the TRIAD study. Ann Intern Med. 2004;141:272-81. [PMID: 15313743] LinkGoogle Scholar9. Asch SM, McGlynn EA, Hogan MM, Hayward RA, Shekelle P, Rubenstein L, et al. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med. 2004;141:938-45. [PMID: 15611491] LinkGoogle Scholar10. Selim AJ, Berlowitz D, Kazis LE, Rogers W, Wright SM, Qian SX, et al. Comparison of health outcomes for male seniors in the Veterans Health Administration and Medicare Advantage plans. Health Serv Res. 2010;45:376-96. [PMID: 20050934] CrossrefMedlineGoogle Scholar11. Petersen LA, Normand SL, Daley J, McNeil BJ. Outcome of myocardial infarction in Veterans Health Administration patients as compared with medicare patients. N Engl J Med. 2000;343:1934-41. [PMID: 11136265] CrossrefMedlineGoogle Scholar12. Fihn SD, Vaughan-Sarrazin M, Lowy E, Popescu I, Maynard C, Rosenthal GE, et al. Declining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care System. BMC Cardiovasc Disord. 2009;9:44. [PMID: 19719849] CrossrefMedlineGoogle Scholar13. Rosenthal GE, Sarrazin MV, Harper DL, Fuehrer SM. Mortality and length of stay in a veterans affairs hospital and private sector hospitals serving a common market. J Gen Intern Med. 2003;18:601-8. [PMID: 12911641] CrossrefMedlineGoogle Scholar14. Nugent GN, Hendricks A, Nugent L, Render ML. Value for taxpayers' dollars: what VA care would cost at medicare prices. Med Care Res Rev. 2004;61:495-508. [PMID: 15536211] CrossrefMedlineGoogle Scholar15. Congressional Budget Office. The Health Care System for Veterans: An Interim Report. December 2007. Washington, DC: Congressional Budget Office; 2007. Accessed at www.cbo.gov/doc.cfm?index=8892&zzz=36275 on 11 February 2011. Google Scholar16. Keating NL, Landrum MB, Lamont EB, Bozeman SR, Krasnow SH, Shulman LN, et al. Quality of care for older patients with cancer in the Veterans Health Administration versus the private sector. A cohort study. Ann Intern Med. 2011;154:727-36. LinkGoogle Scholar17. Koper PC, Stroom JC, van Putten WL, Korevaar GA, Heijmen BJ, Wijnmaalen A, et al. Acute morbidity reduction using 3DCRT for prostate carcinoma: a randomized study. Int J Radiat Oncol Biol Phys. 1999;43:727-34. [PMID: 10098427] CrossrefMedlineGoogle Scholar18. Dearnaley DP, Khoo VS, Norman AR, Meyer L, Nahum A, Tait D, et al. Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial. Lancet. 1999;353:267-72. [PMID: 9929018] CrossrefMedlineGoogle Scholar19. Zietman AL, DeSilvio ML, Slater JD, Rossi CJ, Miller DW, Adams JA, et al. Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA. 2005;294:1233-9. [PMID: 16160131] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095-6900, and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0383.Corresponding Author: Jennifer L. Malin, MD, PhD, Division of Hematology Oncology, Department of Internal Medicine, Veterans Affairs Greater Los Angeles Healthcare System, West Los Angeles Medical Center, 11301 Wilshire Boulevard, Fourth Floor, Los Angeles, CA 90073; e-mail, jennifer.[email protected]gov.Current Author Addresses: Dr. Ryoo: UCLA Jonsson Comprehensive Cancer Center, 650 Charles E. Young Drive South, Room A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900.Dr. Malin: Division of Hematology Oncology, Department of Internal Medicine, Veterans Affairs Greater Los Angeles Healthcare System, West Los Angeles Medical Center, 11301 Wilshire Boulevard, Fourth Floor, Los Angeles, CA 90073. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoQuality of Care for Older Patients With Cancer in the Veterans Health Administration Versus the Private Sector Nancy L. Keating , Mary Beth Landrum , Elizabeth B. Lamont , Samuel R. Bozeman , Steven H. Krasnow , Lawrence N. Shulman , Jennifer R. Brown , Craig C. Earle , William K. Oh , Michael Rabin , and Barbara J. McNeil Metrics Cited ByReducing PSA-Based Prostate Cancer Screening in Men Aged 75 Years and Older with the Use of Highly Specific Computerized Clinical Decision SupportDelivering maximum clinical benefit at an affordable price: engaging stakeholders in cancer careSurvival of Older Patients With Cancer in the Veterans Health Administration Versus Fee-for-Service Medicare 7 June 2011Volume 154, Issue 11Page: 772-773KeywordsColorectal cancerHealth careHealth care qualityHematologic malignanciesHematology and oncologyMedicarePatientsRadiation therapyVeteran careVision ePublished: 7 June 2011 Issue Published: 7 June 2011 CopyrightCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...