VA Health Care For Women:

Despite Progress, Improvements Needed

HRD-92-23: Published: Jan 23, 1992. Publicly Released: Feb 3, 1992.

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Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) progress in improving health care services for female veterans, focusing on: (1) VA progress following a 1982 GAO report; and (2) the remaining barriers that restrict women's access to health care.

GAO found that: (1) since 1982, VA has made significant progress in ensuring that female veterans' access to health care is equal to that of male veterans; (2) VA created an Advisory Committee on Women Veterans and appointed a women veterans coordinator at each medical center, which resulted in increased emphasis on identifying and correcting problems; (3) physical examinations, including cancer screening for female veterans, continue to be sporadic; (4) VA medical centers are inadequately monitoring in-house mammography programs to ensure compliance with the American College of Radiology's standards; (5) centers have inadequate procedures to ensure that patient privacy limitations affecting female patients are identified and corrected during renovations; and (6) it could not identify any programs that were unable to accommodate female patients.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: On March 20, 1992, VA issued directive 10-92-030, which addressed each component of this recommendation.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director to require each medical center, as part of its quality assurance program, to develop and implement an action plan, acceptable to the Chief Medical Director, for improving compliance with the requirement that each woman inpatient receive a complete physical examination, including pelvic and breast examinations and a Pap test, at appropriate intervals. Those plans should, at a minimum, address: (1) the use of nurse practitioners and gynecologists to perform physical examinations; (2) the education and training of medical center staff as to the importance of women-specific services; and (3) quality assurance monitoring.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: As of January 5, 1993, VA has received and reviewed written plans for breast screening services from each VAMC, in accordance with the September 1991 directive 10-91-101.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director to monitor, as part of VA quality assurance activities, centers' compliance with the September 1991 circular on mammography services.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: On March 31, 1992, VA issued directive 10-92-038, which addressed each component of this recommendation.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director to issue guidance to medical centers on: (1) identifying privacy deficiencies in accommodations for women veterans; and (2) instituting a mechanism for tracking corrective actions. The latter should include a center's women veterans coordinator or a representative of the women veterans committee, or both, in the approval process for facility renovation and construction projects, thus helping to ensure that the privacy needs of women patients are adequately addressed.

    Agency Affected: Department of Veterans Affairs

  4. Status: Closed - Implemented

    Comments: VA intends to disseminate information to the field through revisions to its manual on preventive medicine (M-2, Part IV, Chapter 9). For example, VA has issued a directive revising this manual to identify mammography as the Preventive Medicine Program "Special Initiative" for fiscal year 1993.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director to ensure that innovative practices for improving health services to women veterans are identified, disseminated, and, where appropriate, implemented throughout the system.

    Agency Affected: Department of Veterans Affairs

 

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