VA -- more than fine

WaPo reports on the sixth year in a row that the VA has outperformed the private sector in customer satisfaction:

Inpatient care received a rating of 83 on a 100-point scale; outpatient care got a rating of 80. In comparison, a similar survey of patients receiving private care found they rated their satisfaction at 73 for inpatient care and 75 for outpatient care.

Nicholson attributed the high ratings to the changes in the system, such as implementation of electronic records to reduce the risk of errors.

"Our system has become not only much more efficient, but safer," Nicholson said.

The VA is the only completely insulated government-run system in the U.S.  Medicaid and Medicare, although their growth of spending tends to be much more predictable than the private sector, still exist within it.  They rely on our fractured care delivery system, lack of preventative care, and inefficient system of paperwork and hard copy medical records.  In the private sector, that means to uncontrolled spending, bad health outcomes, and especially medical errors.

The VA not only routinely out-performs the private sector, it arrived at that level of quality after years at the bottom of the barrel.  When conservatives harp about Medicare Part D and conclude "government can't do anything right" -- here's another direction to point them.  The only truly government-run system in the U.S., and it provides better care than all the others.  Or, you know, we can keep playing "Bush's vision of health care" and let insurance go the way of the drug benefit.

Comments

[J. Puckett]

Hey, very interesting. I had one question about that poll though, and stop me if I'm wrong about my premise, but since the VA is government-run, users of the VA don't have to pay for it directly, right? If this is true -- which I don't actually know if it is -- could it be that because the VA is given to them at no charge their ratings are higher?

[Trapier K. Michael]

That's my question also, Kate. Although I am definitely perking up to this. It is a very good rebuttal to anyone screaming about the ineptitude of government vis a vis our current hybrid system.

Still, I would argue that "our fractured system" is neither government nor free market - hence, it is fractured. Thus, this isn't a win for government in a straight fight with the market.

I would also argue that either a purely government or market system would be preferrable to what we have now. It's still my opinion though that a market beats government command and control.

[AS]

I'm curious as to what the practical translation of a 5 or 10 point difference in customer satisfaction is.

Also, the numbers are interesting in their consistency, but I'm not sure that the VA is a fair or adquate proxy for a nationalized health care system. The VA's base of potential clients is drastically smaller than the entire population of the country, and they inarguably earned the care they get.

[Donna]

My husband uses the VA and Veterans pay $50 a visit. Hospitalization is $800 for ANYTHING for 3 months. For example, if you go in for knee surgery $800. If you have a heart attack within the 3 months - it's covered.

[Rick Latshaw]

Kate,

Customer satisfaction, while important, is a very poor indicator for quality of medical care.

Please take a look at the research literature on customer satisfaction. It shows that the variables that lead to high customer ratings are based on non-clinically based aspects: quality of doctor interpersonal reaction, ease of parking, wait times, etc.

I definitely believe these are items that do need to be addressed, and doctors are abysmal at many of them. At the same time, however, they have little to do with whether or not you get getting the right diagnosis or treatment.

Ask those that are health professionals that have worked at the VA, you'll get a very different answer. The VA has several interesting and leading edge practices/technologies, but overall quality is not good.

[Fard Johnmar]

Hi. I'm sure you've seen Paul Krugman's recent editorial on the VHA. He calls it one of health care's best kept secrets. Given the NY Times' move to paid subscriptions for some online content, it is possible that you didn't see it in the print edition. I've posted on this subject and excerpted from Krugman's editorial on my blog. Click here to check out the post.