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VA Health Care: Resource Allocation Has Improved, but Better Oversight Is Needed

HEHS-97-178 Published: Sep 17, 1997. Publicly Released: Sep 17, 1997.
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Highlights

Pursuant to a congressional request, GAO assessed the Department of Veterans Affairs' (VA): (1) implementation of the Veterans Equitable Resource Allocation System (VERA); (2) monitoring of changes in health care delivery resulting from VERA; and (3) oversight of the network allocation process used to give veterans equitable access to services.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs The Secretary of Veterans Affairs should direct the Under Secretary for Health to develop more timely and detailed indicators of changes in key VERA workload measures and medical care practices to maintain VERA's ability to equitably allocate resources in the future and help ensure that veterans receive the most appropriate care.
Closed – Implemented
VA has taken several steps to respond to this recommendation. As previously reported, VA monitoring of data showed that the number of one-time visits increased substantially in some VISNs after the implementation of VERA. To correct the impact on allocations, VA created a third capitation level of $100 for one-visit patients for fiscal year 1999. VA plans additional steps in 2000 to account for less expensive users of VA health care services. VA has also monitored special care population workloads under VERA to monitor the incentive to serve fewer less expensive patients. VA has found little change in these workload indicators and continues to monitor them. VA has not assessed potentially undesirable changes in medical care practices that could have resulted from VERA allocations.
Department of Veterans Affairs The Secretary of Veterans Affairs should direct the Under Secretary for Health to improve oversight of VISNs' allocation of resources to their facilities by: (1) developing criteria for use in designing VISN resource allocation methods; (2) reviewing and approving these methods; and (3) monitoring the impact of the methods on veterans' equitable access to care.
Closed – Implemented
VA revised its Directive 97-054 to its health care networks regarding their allocation of resources to facilities. The revision states that each network allocation model will support the goal of improving equitable access to care and ensure appropriate allocation of resources to meet that goal. This revision was incorporated into the directive in final on November 19, 1998. In addition, VA has been measuring clinic waiting times since February, 2000 and added more waiting time indicators in February, 2001 that provide information at the network and facility level. This provides VA information for use in assessing the impact of resource allocation on equitable access to care within and between networks.

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Topics

Health care programsHealth resources utilizationHealth services administrationHospital care servicesMedicareMonitoringPatient care servicesPerformance measuresVeterans benefitsVeterans hospitalsAccess to health care