Preprint Article Version 2 This version is not peer-reviewed

An Evaluation of Alternatives for Providing Care to Veterans

Version 1 : Received: 22 June 2018 / Approved: 22 June 2018 / Online: 22 June 2018 (15:49:28 CEST)
Version 2 : Received: 17 July 2018 / Approved: 18 July 2018 / Online: 18 July 2018 (11:28:15 CEST)

A peer-reviewed article of this Preprint also exists.

Fulton, L.V.; Brooks, M.S. An Evaluation of Alternatives for Providing Care to Veterans. Healthcare 2018, 6, 92. Fulton, L.V.; Brooks, M.S. An Evaluation of Alternatives for Providing Care to Veterans. Healthcare 2018, 6, 92.

Journal reference: Healthcare 2018, 6, 92
DOI: 10.3390/healthcare6030092

Abstract

In 2014, a whistleblower reported that many U.S. veterans died while waiting for care at the Phoenix VHA. Problems with veteran’s care through 2018 reveal ongoing and systematic problem.  In March 2018, the VA Inspector General identified critical deficiencies at the Washington, DC VA Medical Center including failures to track patient safety events accurately, ineffective sterile processing, and more than 10 thousand open or pending prosthetic / sensory aid consults. The VHA clearly has problems with access and quality in a budget-constrained environment.  In this policy analysis, four separate interventions that address the gap between the magnitude as well as the use of the VHA’s fixed budget versus access and cost expectations are explored. These policy interventions include maintaining the status quo, returning to a “VHA-only” option, transitioning to a CMS central payer system, and consolidating care under the DoD TRICARE insurance plans. An objective evaluation suggests that extending TRICARE to veterans while phasing out the VHA’s care responsibilities, while politically unpalatable, would likely provide the best of four possible solutions under various criterion weighting schemes.  A central payer solution under the CMS would also be viable consideration.  A Friedman’s test with Wilcoxon rank sum post-hoc tests suggests that TRICARE patient perceptions of quality are superior to VHA and non-VHA / non-DoD (p<.001), that access provided by the TRICARE program is ranked second in terms of venue acceptance only to the CMS solution set based on primary provider acceptance, and that the cost per beneficiary of a TRICARE solution ($6.5K / beneficiary)  is far better than a VHA-only solution ($14.0 K / beneficiary), the CMS central payer solution ($12.2K / beneficiary), or the status quo (between $12.2K and $14.0K / beneficiary).  The intent of this paper is to provoke thoughtful consideration of solutions for providing access to high-quality healthcare for veterans within our outside of the VHA. In this policy analysis, separate interventions that address the gaps between cost, quality, and access are explored. These policy interventions include maintaining the status quo, returning to a VHA-only option, transitioning to a CMS central payer system, and consolidating care under TRICARE.

Subject Areas

health policy, VHA, VA, CMS TRICARE, Scandal

Comments (0)

We encourage comments and feedback from a broad range of readers. See criteria for comments and our diversity statement.

Leave a public comment
Send a private comment to the author(s)
Views 0
Downloads 0
Comments 0
Metrics 0


×
Alerts
Notify me about updates to this article or when a peer-reviewed version is published.