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It may come as a huge surprise to some people that the VA health system is now considered the best medical care in the United States.  Those who had experience with VA health care during the 1970s and 1980s will surely question this statement.  Moreover, how can this be in light of recent investigations into the quality of care provided at the Marion VA Medical Center and other locations throughout the country?

Life Care Planning, Estate Protection, Disability,
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The Best Health Care System in America

The Best Health Care System in America

 

It may come as a huge surprise to some people that the VA health system is now considered the best medical care in the United States.  Those who had experience with VA health care during the 1970s and 1980s will surely question this statement.  Moreover, how can this be in light of recent investigations into the quality of care provided at the Marion VA Medical Center and other locations throughout the country?

 

As background, the following is quoted from an article in the July 17, 2006 edition of BusinessWeek, entitled "The Best Medical Care in the Nation:  How Veterans Affairs Transformed Itself  -  And What It Means for the Rest Of Us."

 

"For decades the VA was the health-care system of last resort... The huge system had deteriorated so badly by the early '90s that Congress considered disbanding it."

 

"Instead, the VA was reinvented in every way possible. In the mid-1990s, Dr. Kenneth W. Kizer, then the VA's Health Under Secretary, installed the most extensive electronic medical-records system in the U.S. Kizer also decentralized decision-making, closed underused hospitals, reallocated resources, and most critically, instituted a culture of accountability and quality measurements. ‘Our whole motivation was to make the system work for the patient,' says Kizer, now director of the National Quality Forum, a nonprofit dedicated to improving health care. ‘We did a top-to-bottom makeover with that goal always in mind.'. . ."

 

Why the VA Health Care System Works so Well

 

Actually it's not that VA is such a marvelous system, since any large-scale organization employing over 200,000 people is bound to have its inefficiencies. VA simply comes closer to the mark of providing excellent care than the rest of the health-care providers in the country. One big reason is the veteran system does not rely on insurance reimbursements, so money saved through efficient operation remains in the system and does not transfer to insurance companies. This type of operational structure encourages innovation and change.

 

However, being a single-payer health plan alone would not necessarily result in a better system. The outstanding reawakening of VA health care is largely a result of the vision and leadership of Doctor Kizer and his successor. Here are some of the operational advantages that make VA health care so successful.

 

As a government entity, the agency cannot be sued by patients who have been mistreated. This obviously saves the time and money involved in defending against lawsuits. However, in order to be responsive to medical errors, Doctor Kizer instituted the "Sorry Now" program that holds staff accountable for their actions and provides damage awards to patients who have been harmed through staff negligence.

 

Moreover, staff accountability is enhanced by a program that includes internal quality control management and outside auditors that review the care, treatment, and services provided to veterans selected at random.  The quality control managers and auditors look at the interaction between the patient and every staff person who had contact with the patient during his or her visit to the facility, and mentor each staff person to determine whether there were any flaws or there might have been a better way of providing the services the patient required.

 

Veterans who are part of the system have the opportunity to remain with the system throughout their lives. This allows VA to practice preventative medicine by scheduling regular checkups, performing regular lab tests and intervening before a medical condition becomes too advanced. The health insurance reimbursement model used outside the VA medical system typically does not allow for this type of preventative medicine.

 

The electronic records system also allows each of the VA medical facilities across the country to have access to a veteran's past medical records.  This is important when a veteran moves to a new location, is on vacation or traveling, or, regrettably, is homeless and moves around the country.

 

In addition, an electronic records system provides the opportunity to practice outcome-based medicine which has become the Holy Grail of all health-care systems. The computerized records allow tracking outcomes for various medical conditions and finding those that work best. This weeds out expensive procedures that are no more effective than other less expensive ones. Prescriptions for medications are also tracked on the computer and potential drug interactions are avoided. According to studies, VA has the lowest drug interaction incidents and deaths in the country

 

The electronic records also prevent duplication of expensive medical tests. Some surveys indicate that, 60% of the time, private sector providers order duplicates or triplicates of the same test. This is because paper records make it difficult or almost impossible to track tests between different care providers. Even in the same hospital, estimates are that one out of five tests is unnecessarily reordered.

 

Finally, electronic records help the veterans' medical system to maintain a more cost effective and smaller drug formulary. Fewer categories of drugs allow VA to negotiate with drug companies for larger quantities at a lower price. If an existing, less expensive drug is proven through electronic records to be just as effective as newer more expensive medicines, then obviously the older medicine will be favored.

 

Proponents of the new Medicare drug plans criticize VA for limiting drug choice to only about 1,300 medications where some Medicare plans allow 4,500 different drugs or more. VA would probably argue that such a wide choice is unnecessary and that many newer more expensive drugs are simply analogues of less expensive versions that have been around for a long time.

 

Cost of overhead and administration is another issue that makes VA a better system. Our country's private insurance model results in insurers eating up a great deal of their premium income in unproductive overhead costs. It is estimated that private insurers spend anywhere from 20% to 30% of their premium income on advertising, agent commissions, insurance administrative oversight costs, expensive claims and records tracking systems, taxes, profit, and dividends for shareholders. VA has none of these additional cost burdens except for administrative costs associated with maintaining the system.

 

Although there is always room for improvement, based on the reports I receive, it appears the morale of employees in VA hospitals and outpatient clinics around the country is especially high because of the pride those employees take in providing quality care.  Motivated employees can be a major factor in providing care more effectively and more efficiently  -  thus saving money.

 

Richard Habiger is an elder law, VA benefits, and life care planning attorney.  You may contact him at 618-549-4529 or Richard@HabigerElderLaw.com.

 

 


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Toll Free: 800-336-4529

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Phone: (618) 985-4529