Doctoring Health Care Health Care Reform

VA hospitals do not deliver inferior care

Bernie Sanders has intensified the debate about US healthcare. Specifically, he has people talking about a single-payer government-controlled system.

Critics, uninformed as they are, point to the VA system as an example of inferior care.

A well-conducted study refutes such misthink.

Yale researchers performed a massive cross-sectional study to compare outcomes among older men in VA versus Non-VA hospitals. The prestigious Journal of the American Medical Association published their paper.

They looked at standard outcomes for heart attack, heart failure and pneumonia.

The bottom-line message of the results: there was essentially no difference. For heart attack and heart failure, death rates actually trended a little lower in the VA, while readmission rates trended slightly higher in VA hospitals.

The research team even looked at outcomes within the same metro district so as to control for geographic differences. Again, essentially the same outcomes.

This is a damn important story. I see three messages.

One is that the results don’t surprise me. Acute care of ill patients is the easiest part of medicine. Care of chronic conditions is tougher–and, I’ll add, much more susceptible to the harms of over-treatment favored in the fee-for-service system.

The second message: Don’t believe the mainstream American bias that VA hospitals are inferior. Remember those stories about VA waiting lists? One of the responses to this was to allow veterans access to private systems that were closer. But that assumes faster care at private hospitals is better. I work in Kentucky; I know that’s not a good assumption.

The most important message is this: The VA is a closed single-payer healthcare system. This study shows that it delivers acute care similar to that seen in the private sector. That sends a big message about health care policy.

I work in the private sector of healthcare. It’s wasteful, costly, inefficient, unfair, and make no mistake, it denies and rations care. It’s a national embarrassment.

The VA system is not perfect, but US healthcare would do well to be more like the VA.


2 replies on “VA hospitals do not deliver inferior care”

Being a retired Air Force healthcare administrator, I know a thing or two about a closed system for healthcare. I was ashamed when I went to work in the civilian healthcare system and was constantly asked by my boss (the CEO) “how much money did we make today?”, as if that was a mark of success. A better question would have been, “what do our patients think of us” or “what are our medical outcomes?” Needless to say, I didn’t stay in healthcare.

Here is another hypothesis. Maybe outcomes are no different because the private sector, while providing better access, does little to change outcomes. Or maybe avoiding access to some medical care is a good thing. ( ie avoiding exposure to mrsa or medical mistakes)

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