The VA, reprise

Several of you (via email and comments here and at Ezra's) seem to think I'm claiming the VA's superiority based solely on customer satisfaction information.  I understand your concern about this claim, because to do so would be utterly ridiculous.  Just because people like something better doesn't mean it works better. 

I used the patient satisifaction information on top of the information I've read several places about the VA's excellent patient results and treatment standards.  I've dug some of it up to prove I'm not that crazy.

From the New England Journal of Medicine:
 

In fiscal year 2000, throughout the VA system, the percentage of patients receiving appropriate care was 90 percent or greater for 9 of 17 quality-of-care indicators and exceeded 70 percent for 13 of 17 indicators. There were statistically significant improvements in quality from 1994–1995 through 2000 for all nine indicators that were collected in all years. As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through
1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators. 

The quality of care in the VA health care system substantially improved after the implementation of a system-wide reengineering and, during the period from 1997 through 2000, was significantly better than that in the Medicare fee-for-service program. These data suggest that the quality-improvement initiatives adopted by the VA in the mid-1990s were effective.

From the Washington Monthly:

The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care. It gets stranger. Pushed by large employers who are eager to know what they are buying when they purchase health care for their employees, an outfit called the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose this year's winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.

Substantive research, along with patient satisfaction, shows that the care delivered at the VA, once the worst in the country, is now among the best. 

Something else the VA has that rest of us non-vets don't?  Electronic medical records, which have transformed efficiency and standards of care.  It's the only example of in-the-U.S. totally government-run medicine, and it works.  Bettter than Medicare, and much better than the private sector. 
 

Thanks to Martin for digging up the NEJM article

Comments

[eric]

Isn't the Indian Health Service also an example of in-the-US totally government-run healthcare?

[Maracel]

Maybe the public should be able to buy in.

[Martin]

The public should definitely be able to buy into the VA, but in California they do have the option of buying into the Kaiser system, which is a not for profit, private sector analog of the VA system. A major reason why VA style care will never spread across the country is that the VA is, essentially, an HMO and HMOs are considered non grata by most purchasers of health care these days. That Kaiser is a staff model HMO is irrelevant to most purchasers. There are significant differences between staff and network model HMOs. Arguably, staff model HMOs achieve the vision of an HMO while network model HMOs do not because they use a network of contracted physicians rather than employing the physicians.

[Trapier K. Michael]

Ok Kate,

Can you explain why the VA Sect. said in 2003 that the "the agency was struggling to provide adequate health care" to its patients? [1]

Trapier
www.marketplace.md

[1]http://news.yahoo.com/s/ap/20060125/ap_on_he_me/veterans_no_care;_ylt=Av1ToL46iS8gIBKT9NONozdZ24cA;_ylu=X3oDMTBiMW04NW9mBHNlYwMlJVRPUCUl