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Saturday, January 4, 2014

Are VA hospitals really failing our veterans?

Dr. Matthew B. Candelaria

If you listen to people talk, there are many stories of Veterans Administration hospitals that are causing problems for our veterans, with either bureaucratic failings or just poor care resulting in additional injuries, prolonged hospital stays, and more.

But if you look, you can find just as many terrible stories that occur at private hospitals. When we look at the full story, are VA hospitals worse than other hospitals, or is it just selective anecdotes that highlight a few instances of poor care that make it seem so?

Assessing the quality of care in general

Preventative care is better at VA hospitals per research
VA hospitals are reviewed for quality control
There is a huge amount of data comparing the performance of VA hospitals and private hospitals. Since the VA is often accused of falling below the standards of private hospitals, the VA often conducts standardized comparisons to try to ensure that they are actually providing a comparable quality of care.

A recent review, for example, found 175 studies comparing the quality of care between VA and private hospitals, though only 36 met their criteria of providing specific data-based comparisons between the two fields. They concluded that VA hospitals had:
  • Better adherence to standard of care
  • Often better health outcomes
  • More evidence-based drug use
  • No clear survival difference between VA and private care hospitals
This review shows a pretty conclusive argument that care at VA hospitals is at worst no better than private hospital care, and quite possibly better.

In Cleveland, the VA rocks cardiovascular care

We can also look at more focused studies of care looking at individual populations. For example, a 2003 study compared the performance of a VA hospital and private hospitals in Cleveland. The study found that mortality rates were slightly in the advantage of VA hospitals (5.0% vs. 5.6%, respectively), and in some areas the VA is really superior. For example, stroke mortality rate in private hospitals was 9.2%, compared to only 6.5% for the VA, and the difference in heart attacks was even greater: 10.1% mortality in private sector hospitals vs. 1.1% for the VA. On the other hand, the VA had much greater mortality rate for lower bowel resection: 10.9% in the VA vs. 3.7% in the private sector.

The VA delivers better preventive care

A 2004 analysis of medical records of VA and private care patients found that the VA was much better at delivering preventive and chronic care than private practice. Including:
  • VA patients received about two-thirds of recommended care vs. about half for private patients
  • VA patients received 65% of preventive care treatments recommended, compared to only 20% for private care
  • In chronic care, VA patients received 70% of recommended care, but private care patients only got 60%.
  • In acute care, the two populations were similar
Overall, then the conclusion is that the VA offers better ongoing care than most people receive under private care.

Doing more with less

In recent years, the number of people in the VA system has increased significantly as a result of the Iraq and Afghanistan conflicts. Although the budget for the VA has not been cut, it has also not been increased proportionately with the number of veterans. As a result, the cost per patient to care for veterans fell by 29.0% from 1999 to 2005, a period in which private health care costs were rising by 6% or more. After adjusting for the severity of patient care, costs actually grew by
1.7%, but this is still well below the private sector cost increases.

Where do tragic stories come from?

If the VA is doing such a good job overall of caring for Veterans, why are there so many stories floating around about poor care?

Partly, there are so many stories around because even the best care is lacking significantly. Consider, for example, that even VA patients only receive two-thirds of the recommended care, which, if you or your loved one is in that other third, is clearly unacceptable.

Another reason why these stories spread is that they are quality emotional stories. We all want our veterans to be cared for, and when it seems like we're not repaying them for their service we tend to get upset. This emotional quality makes it more likely that this type of story will hit the front page or top of the hour if it has a veteran in it.

And, of course, there are some VA facilities that have real problems. We need to continue working to improve VA care, but it's a disservice to the doctors and administrators of VA hospitals, many of them veterans themselves, to discredit the entire system.

About the author: Dr. Matthew B. Candelaria (PhD, U of Kansas 2006) is an independent researcher on health, science, and public policy issues. He has published thousands of articles on topics ranging from dentistry and medical malpractice to solar energy and computer security.

Image license: US-PDGov