兰德-Balancing-Demand-and-Supply-for-Veterans-Health-Care_-A-Summary-of-Three-RAND-Assessments-Conducted-Under-the-Veterans-Choice-Act_24页_1mb

Summary of RAND Assessments on Veterans’ Health Care under the Veterans Choice Act

Core Content

This document summarizes three RAND assessments conducted under the Veterans Choice Act, focusing on demand and supply of VA health care services and policy considerations for purchased care. The assessments aim to improve the match between veterans' needs and VA's capabilities, ensuring high-quality, timely, and accessible care.

Main Findings

Veteran Demographics and Health Needs

• The U.S. veteran population has been declining since 1980, with a projected 19% reduction between 2014 and 2024.
• The median age of veterans is increasing, and they are becoming more geographically concentrated, particularly in the South and West.
• Veterans who use VA care tend to be older, sicker, and more likely to have service-connected health issues such as cancer, diabetes, and PTSD.
• However, veterans who rely most on VA are often younger, poorer, and live in rural areas, with limited access to other health care sources.

Demand for VA Health Care

• Demand is expected to increase through 2019, driven by the growing proportion of veterans with complex health needs and the aging population.
• By 2020, demand is projected to level off or decline, unless there is a new conflict or policy change.
• The demand for specialty care (e.g., pain medicine, neurology, dermatology) is expected to rise significantly.
• Veterans with service-connected injuries are more likely to use VA services, and their health needs are more complex than those of non-veterans.

VA Supply and Access

• VA operates a large and diverse health care system, including 144 hospitals, 700 outpatient clinics, and over 55,000 employed clinicians.
• Geographic access to VA care is uneven, with only 25% of veterans living within a 60-minute transit time to a VA facility.
• Access to specialty care is particularly limited, with fewer than half of veterans living within 40 miles of VA specialty services.
• Appointment wait times vary significantly across VA facilities, with some veterans waiting more than 60 days for care.
• Most veterans receive care within 30 days of their preferred date, but this is not consistent across all VA facilities.

Quality of Care

• VA care is generally equal to or better than non-VA care, but there is significant variation across VA facilities and types of care.
• VA outpatient care outperforms non-VA care on most quality measures, while inpatient care performance is mixed.
• Quality monitoring of purchased care is inadequate, and there is no reliable data on the timeliness and quality of non-VA services.

Policy Considerations for Purchased Care

Current Trends in Purchased Care

• The use of purchased care has grown significantly, with VA spending $5.6 billion in 2014 on purchased care (9.4% of total medical expenditures).
• The Veterans Choice Act added $10 billion to VA's budget to expand purchased care from 2015 to 2017.
• VA's purchased care system is complex and fragmented, with multiple mechanisms for purchasing care, each with different policies and oversight.

Key Issues Identified

• Lack of a clear strategy for purchased care.
• Inconsistent administration and referral procedures across VA facilities.
• Limited oversight and monitoring of purchased care quality and timeliness.
• Need for better coordination between VA and private providers.

Recommendations for Policymakers

• Develop a clear strategy for purchased care that aligns with the evolving needs of the veteran population.
• Consider consolidating purchased care functions to improve efficiency and oversight.
• Enhance relationships with private providers to improve access and quality.
• Modify eligibility requirements for purchased care to better match veterans' needs.
• Improve the management of purchased care programs and contracting processes.
• Focus on value-based care to ensure that purchased care improves clinical quality and cost-effectiveness.
• Expand veterans’ choices to access care outside the traditional VA system, including through private providers and other government facilities.

Conclusion

The RAND assessments highlight the need for strategic planning and policy reform to ensure that the VA can continue to provide high-quality, timely, and accessible health care to veterans. With the aging veteran population and the potential for future conflicts, flexibility in care delivery and improved coordination between VA and private providers will be essential. Policymakers and VA leaders must work together to address short-term and long-term challenges in the delivery of health care services to veterans.