Quality of Care
A common complaint about the VA health system is the long wait time. This means that care is not being provided in a timely manner. This is because there are not enough doctors, nurses, other medical staff, and hospitals to accommodate all VA members and their needs. This limits access to care, which is likely to decrease desired health outcomes as described in the definition of quality of care. It was also reported that claims for disability, which the VA uses to determine the amount of cost-sharing, can take up to 36 months in some areas (LaForce, 2017). This can also hinder access to care, which would decrease quality given the definition used for this criterion.
Due to the long wait times experienced by some VA members, have resorted to going without care or (in some extreme instances) killing themselves (LaForce, 2017). As population health is related to the health outcomes of a group of individuals, if individuals in that group have declining health or are killing themselves it can be said that population health is decreasing rather than improving.
Cost of Care
Due to the VA assuming most of the risk as the single-payer, it has resorted to rationing care as a means of reducing its risk. If tax dollars will not cover care, care must be rationed. As stated previously, most veterans have low to no copays for most services and prescriptions. However, there is a tradeoff. While the VA is reducing the financial cost of care, there are other implications.
Rationing of Care
As the VA offers low to no-cost insurance to its members, it resorts to supply-side, or nonprice, rationing to control utilization. With this type of rationing, resources are limited. While the VA is not purposely limiting access to care, it does not have enough resources to accommodate its members. This results in the rationing of care. The VA’s rationing of care comes in the form of long wait times. Patients have died while waiting to receive care. In a 2018 report, it was revealed that patients at the Washington, D.C. VA Medical Center underwent prolonged anesthesia because the necessary surgical instruments for their procedures were not available. Doctors and nurses at that facility also admitted to borrowing supplies from a nearby hospital to try to overcome the shortages (Spradley, 2019). Due to being underfunded and over budget, the VA Health System is unable to manage its facilities to offer care to all its members in a timely manner.
The VA hospital has a performance metric with the goal of seeing veterans for non-urgent appointments within 2 weeks. The VA offers financial incentives to hospitals that meet this metric. As a result of cheating metrics relating to the wait time, the VA hospital in Phoenix is responsible for 40 deaths (Klein, 2014). At the Phoenix location and others, administrators created secret waiting lists to hide the true wait times.
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