Healthy Policy

The VA tackles obesity and diabetes

The Veterans Affairs health system is rolling out a new program to combat obesity and diabetes among veterans:

As part of the new program, VA doctors will give out "prescriptions for health" to patients after measuring their body mass index, a measure of body fat. The prescriptions will list exercises and nutritional information that match patients' health needs.

Their excellent HIT infrastructure will provide easy assistance in implementing this program.  We're desperately in need of solid public health and prevention programs; success here could indicate a model for other practitioners to adopt. 

Further, VA members actually have a problem with obesity and diabetes.  70% are obese, compared to 31% of the general population.  An astounding 20% have diabetes, compared with 7% of non-vets.  So there's real room for improvement. 

VA, threeprise

Looks like I'm not the only one extolling the virtues of the VA:

Well, I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system's success provides a helpful corrective to anti-government ideology. For the government doesn't just pay the bills in this system — it runs the hospitals and clinics.

No, I'm not talking about some faraway country. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate.

That's Paul Krugman in today's Times (select) column. 

Best-kept secret huh?  I'm not so sure about that. 

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

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.

The VA is my hero

Another part of Moran's essay features a nifty graph of Medicare versus VA spending.

There is much, much more to this graph besides the cost containment difference. Since 1995 the number of patients in the VA system has doubled to about 5.2 million. This is while over 12,000 staff were cut and the cost per patient was reduced by half. The VA often out performs the private sector -- check out these results

In 1990, before Baltimore began tracking its performance, rates of screening for breast and cervical cancer were 50 percent and 17 percent, respectively. In 2003, they were 88 percent and 87 percent.
Medicare officials point out that the VA has the advantage of being an integrated delivery system -- that is, a health plan in which most of the doctors are salaried employees and all care is coordinated and tracked. In Medicare, physicians work for themselves and patients are free to pick and choose their services.

The VA is a beautiful thing, people.