The Veterans Healthcare Administration

Healthcare is one of the United States’ most valued commodities. The average American holds it at such great importance that on average, families are even spending more on healthcare than they do on basic commodities. It is such a big concern for all Americans that statistical data indicates healthcare expenses as accounting for 17% of the gross domestic product – by far the biggest share representation worldwide. American workers are even willing to forego wage hikes in favor of better coverage or higher deductibles and co-pay packages.

Even in the current economic situation where large groups of workers are losing or have become incapable of affording coverage, citizens and policy makers are still clamoring to avail of and/or find means to provide insurance coverage to the ever growing numbers of the unemployed and uninsured. In such an environment where healthcare coverage is greatly desired and needed by so many, the existence of an agency capable of providing coverage to a wide population can be of utmost importance and great comfort to the American public.

Luckily, such an organization already exists in the form of the Veterans Healthcare Administration. What is the Veterans Healthcare Administration (VHA)? The Veterans Healthcare Administration or VHA is a medical assistance program of the United States Department of Veterans Affairs (VA). As a component of the VA, the VHA is responsible for overseeing the administration, operation and implementation of several health programs and facilities designed to cater to the health needs of eligible veterans and their dependents.

The VHA health care system “is the largest integrated healthcare system in the nation, providing approximately 780,000 acute hospital admissions and over 35 million outpatient visits per year” (US Department of Veteran Affairs). Originally rooted and designed to address the treatment of injured soldiers, the VHA – in the years before and after1995 – played a vital role in the healthcare industry as a safety net due to its accessibility to uninsured poor veterans (Iglehart, 1996, p. 1407).

After reforms have transformed and streamlined the program, the VHA has now gone beyond the provision of primary care and is now offering specialized assistance through customized programs. Despite being criticized as an anomaly and “a dangerous backwater of medicine” (Gaul, 2005, p. 1), after its successful reform and restructuring, it is now lauded as a desirable model for healthcare systems throughout the United States. History The VHA benefits system has its earliest roots traced back to 1636 during the war between Pilgrims of the Plymouth Colony and the Pequot Indians.

During this period, pilgrims passed a law which stated that soldiers disabled by the war be supported by the colony. More than a century later in the year 1776 the continental congress used the system as a means toward encouraging enlistment during the Revolutionary War. During this period of the Republic, soldiers that were disabled were awarded pensions and direct medical and hospital care were provided by individual states and communities.

By 1811 the Federal government has authorized the establishment of the first domiciliary and medical facility for veterans. Upon entering the 19th century, the VA program was then expanded to “include benefits and pensions not only for veterans, but also their widows and dependents. ” Eventually domiciliary care became available within all established State veterans homes which provided incidental medical and hospital treatment for various injuries and illnesses regardless of whether these were service related or not.

(US Department of Veteran Affairs, 2006). Upon the onset of World War I in 1917, the United States Congress established a new system of veterans benefits. This included programs such as “disability compensation, insurance for servicepersons and veterans, and vocational rehabilitation for the disabled. ” By the 1920s three different Federal agencies handled the administration of benefits: “the Veterans Bureau, the Bureau of Pensions of the Interior Department, and the National Home for Disabled Volunteer Soldiers” (US Department of Veteran Affairs, 2006).

Finally by 1930 the Veterans Administration came into being after Congress authorized the consolidation and coordination of government activities affecting war veterans. The previously mentioned agencies became bureaus within the VA. In the next few years the VA health care system grew from 54 hospitals in 1930 “to include 171 medical centers; more than 350 outpatient, community, and outreach clinics; 126 nursing home care units; and 35 domiciliaries. ” These facilities boasted a broad spectrum of medical, surgical and rehabilitative services.

By World War II, Congress enacted new benefits through the GI bill which was signed into law on 22 June 1944 (US Department of Veteran Affairs, 2006). Lastly, “The Department of Veterans Affairs (VA) was established as a Cabinet-level position on March 15, 1989. President Bush hailed the creation of the new Department saying, ‘There is only one place for the veterans of America, in the Cabinet Room, at the table with the President of the United States of America’” (US Department of Veteran Affairs, 2006). Overview of the VHA and its Mission/Vision

The Veterans Healthcare Administration is a component of the United States Department of Veteran Affairs (VA) and is required by law “to provide eligible veterans hospital care and outpatient care services that are defined as ‘needed’” (US Department of Veteran Affairs, 2007). “Needed,” as defined by the VA are services meant to promote, preserve, and restore health and includes a wide array of treatments, procedures, supplies and services available in the healthcare market (Veterans Healthcare Overview). The VHA operates under the mission:

…[T]he Veterans Healthcare System is to serve the needs of America’s veterans by providing primary care, specialized care, and related medical and social support services. To accomplish this mission, VHA needs to be a comprehensive, integrated healthcare system that provides excellence in health care value, excellence in service as defined by its customers, and excellence in education and research, and needs to be an organization characterized by exceptional accountability and by being an employer of choice. (US Department of Veteran Affairs, 2007).

As an organization, the VHA functions under the vision that the value of healthcare begins with VA. To support this new system, the VA aims to utilize “innovation, empowerment, productivity, accountability and continuous improvement” in order to realize this vision. As a cooperative system, the VHA aims to provide “a continuum of high quality health care in a convenient, responsive, caring manner—and at a reasonable cost” (US Department of Veteran Affairs, 2007). Benefits and Programs Under the VHA As a member of the VHA system, qualified veterans and their dependents are entitled to the following standard benefits.

Preventive care services under the standard benefits package include immunization, physical examinations inclusive of eye and hearing examinations, health care assessments, screening tests and health education programs. Also available under the standard benefits package are ambulatory/outpatient and hospital services inclusive of diagnostic and treatment services which cover medical, surgical (including reconstructive/plastic surgery as a result of disease or trauma), substance abuse and mental health assistance (US Department of Veteran Affairs, 2008).

Enrolled veterans also qualify for the following limited services upon fulfilling special eligibility criteria (to be discussed later in detail in the following pages): “ambulance services, dental care, durable medical equipment, eyeglasses, hearing aids, home health care, maternity and parturition services (provided in non-VA contracted hospitals at VA expense, care is limited to the mother [costs associated with the care of newborn are not covered]) and non-VA health care services.

” However, the following services/procedures are some of the general exclusions exercised by the VHA: “abortions and abortion counseling, cosmetic surgery except where determined by VA to be medically necessary for reconstructive or psychiatric care, gender alteration, health club or spa membership – even for rehabilitation, in-vitro fertilization, drugs, biological, and medical devices not approved by the Food and Drug Administration unless part of formal clinical trial under an approved research program or when prescribed under a compassionate use exemption, medical care for a veteran who is either a patient or inmate in an institution of another government agency if that agency has a duty to provide the care or services, services not ordered and provided by licensed/accredited professional staff and special private duty nursing” (US Department of Veteran Affairs, 2008). The VHA also provides long-term care benefits for enrolled members and these include the following: First is Geriatric Evaluation which is a comprehensive system designed to assess a veteran’s ability for self-care in all areas of daily living (physical, social, mental, emotional etc. ).

This allows for the development of a care plan that may include treatment, rehabilitation, health promotion and social services. Evaluations are performed by inpatient Geriatric Evaluation and Management (GEM) Units, GEM clinics, geriatric primary care clinics, and other outpatient settings (US Department of Veteran Affairs, 2008). Another long-term care service provided is the Adult Day Health Care which is a therapeutic day care program designed to provide medical and rehabilitation services to disabled veterans in a combined setting. Respite Care on the other hand is a short-term supportive care designed to provide caregivers “a planned period of relief from the physical and emotional demands associated with providing care.

” The service may be given in the home or other non-institutional settings (US Department of Veteran Affairs, 2008). The VHA also provides Home care to home-bound veterans with chronic diseases via contract agencies that can provide nursing, physical/occupational therapy and social services. Finally the VHA also provides Hospice and Palliative care to terminally ill veterans and veterans on the late stages of chronic disease. Service includes the provision of pain management, symptom control, other related medical services including respite care and bereavement counseling. The Veterans Health Administration has a very extensive list of clinical programs under their implementation and supervision.

Programs include “Agent Orange Health Effects and Vietnam Veterans, Blind Rehabilitation Services, Cancer Program, Center for Women Veterans, Cold Injury, Diabetes Program, Flu (Influenza-Pandemic), Gulf War Veterans’ Health, Health Care Programs for Elderly Veterans, Hepatitis C, HIV/AIDS Program, Homeless, Kidney Diseases Program, Mental Health, Mental Illness Research, Education and Clinical Centers (MIRECC), National Center for Post-Traumatic Stress Disorder, National Center Patient Safety, Nursing, Polytrauma, Prosthetics and Sensory Aids, Recreation/Creative Arts Therapy Service, Social Work, War-Related Illness and Injury Study Center” (US Department of Veteran Affairs, 2008). Some of these are discussed in the following texts. One of the services worth noting is the HIV/AIDS program run by the Public Health Strategic Health Care Group (PHSHCG). Through this subgroup, the VA has managed to become the single highest provider of HIV and Hepatitis C care in the United States.

In 2000 alone 19,000 veterans received care for HIV and over 70,000 VA veterans were diagnosed for Hepatitis C (Military Advantage, 2009). Another program worthy of note is the Blind Rehabilitation Service which: […]coordinate a healthcare service delivery system that provides a continuum of care for blinded veterans extending from their home environment to the local VA facility and to the appropriate rehabilitation setting […] services include adjustment to blindness counseling, patient and family education, benefits analysis, comprehensive residential inpatient training, outpatient rehabilitation services, the provision of assistive technology, and research (Military Advantage, 2009).

Thirdly, to address health issues brought about by the exposure to Agent Orange during Vietnam War, veterans are provided with healthcare services and disability compensation specific to the elements of the Agent Orange Exposure program. The program also handles service connected illnesses and performs scientific research, education and outreach activities. The official VA website located at www. va. gov can be visited for more details on the other mentioned programs. Demographic Served, Eligibility and Funding The VHA serves a wide range of demographics with only one restricting criterion: members must be veterans of the US Armed forces (Military, Navy etc. ) and the coverage extends to their dependents.

Members must also be enrolled (if not automatically enrolled as a result of recent (honorable) discharge from service and fulfill certain qualifications. Enrollment and eligibility is dependent on numerous variables such as nature of discharge (honorable, dishonorable, other than honorable etc. ), service duration, VA adjudicated disabilities or service-connected disabilities, income, and available resource among others. Enrollment is also done under a priority system, where enrollees are categorized into one of eight categories with category I being of highest priority. The priority groups are discussed as follows. Priority Group I (PG-I) are veterans who incurred service-related disabilities rated as 50% disabling and who are deemed unemployable due to the service-connected condition.

Those who incurred service-related disabilities deemed 30-40% disabling are categorized as PG-II. Those categorized under PG-III satisfy any of the following criteria: with service-related disabilities rated as 10-20% disabling, former prisoners of war (PoW), Purple Heart awardees, veterans discharged due a disability that began in service and those who were disabled because of VA treatment or rehabilitation. Veterans who are currently receiving aid and housebound benefits and those who are deemed catastrophically disabled are grouped under PG-IV. PG-V consists of veterans receiving VA pension benefits, eligible for Medicaid programs and whose income and assets are below the VA Means Test Threshold.

On the other hand those who have 0% service-connected conditions and receiving VA compensation; those seeking care for any of the following: disorders relating to Ionizing Radiation and Project 112/SHAD, Agent Orange Exposure, Gulf War Illness or for conditions related to exposure in the Persian Gulf; veterans of WWI and the Mexican Border war; those who served in combat in a war after the Gulf War are categorized under PG-VI. PG-VII consists of veterans who agreed to pay specific co-pays. These are veterans whose income is above the VA income threshold but below the Geographic Means Test Threshold. PG-VII has subpriority groups labeled a, c, e and g with each its own determining factor.

Lastly, PG-VIII is similar to PG-VII but whose enrollees are “with income and/or net worth above VA Means Test threshold and the Geographic Means Test Threshold. ” PG-VIII also has a subpriority grouping similar with that of PG-VII. Since VHA is a subcomponent of the Department of Veteran Affairs ( a member of the presidential cabinet), funding for the organization is reliant on a pre-approved congressional budget appropriation. House bills are annually introduced, reviewed and passed in order to raise funding. In 2008, the VHA received its highest appropriation, amounting to “$3. 7 billion in additional veterans funding provided by Congress” – the largest increase in its 77 year history (Asianjournal, 2008). Issues and Future of the VHA The VHA since its conception has had its fair share of issues.

The VHA has been said to be a sprawling healthcare system, a backwater of medicine suffocated with bureaucracy, unsafe hospitals back in the early 1990s (Gaul, 2005, p. 1). It has faced issues with funding such as inappropriate purchases (Williams, 2004, p. 1) and uncontrolled use of miscellaneous obligations (All Business, 2008, p. 1). However, despite these criticisms and controversies, the VHA has pursued reforms and programs that addressed these issues. In 1996, the VHA initiated change by reengineering the department’s medical system. This led to the reform of the eligibility requirements, the initiation of new payment methods and the modernization of its information system.

As a result, through the VHA’s personal efforts medical error in its system have been reduced by 70% all thanks to the VHAs efforts at introducing the Bar Code Medication Administration system, a system developed jointly by EDS and VHA staff. Its other computerized system, widely known as VisTa, is now a staple of many medical facilities – a true sign that VHA has become an influencing and transforming force in the healthcare industry. VHA greatly owes this recent recognition through “its use of electronic medical records, its focus on preventive care and its outstanding results. ” And becase of this, the VHA now outperforms Medicare and most private health plans in various area of quality measure including diabetes care, managing high blood pressure and caring for heart attack patients.

To quote Gaul’s article “the VA makeover as a lesson in how the nation’s troubled health care system might be able to heal itself…[The VHA] is especially impressive because this is a massive system that works in a fishbowl, is under tremendous scrutiny and has constrained resources” yet it has flourished silently within the past decade. Truly the VHA is an agency capable of providing coverage to a wide population and is of utmost importance and great comfort to the American public and its valued veterans.


All Business (2008). Veterans Health Administration: Improvements Needed in Design of Controls over Miscellaneous… AllBusiness. com. Retrieved January 18, 2009 from http://www. allbusiness. com/population-demographics/demographic-groups-veterans/11509161-1. html Asian Journal (2008). Largest increase in veterans’ healthcare in history released. Asian Journal Publication Jan 25-31, 2008. Retrieved on January 17, 2009 from http://72. 14.

235. 132/search? q=cache:PjE1oOzI12UJ:www. asianjournal. com/pdf/PDF/2008_OC/2008_01_25/2008_01_25_OC_sec1p%25203. pdf+veterans+healthcare+funding&hl=en&ct=clnk&cd=3&gl=ph Gaul, G. M. (2005). Revamped Veterans Healthcare now a new model. Washington Post. Iglehart, J. K. (1996). Reform of the Veterans Affair health care system. Health Policy Report 18 vol. 335. Massachusetts Medical Society. Military Advantage. (2009). Veterans health care overview. Military. com updated January 2009. Retrieved January 14, 2009 from http://www. military. com/benefits/veterans-health-care/veterans-health-care-overview#1 US Department of Veteran Affairs. (2008).

Veterans Health Administration: VA Healthcare overview. Health Administration Center Communications Division. US Department of Veteran Affairs. (2007). About VHA. Www. va. gov updated August 29, 2007. Retrieved January 16, 2009 from http://www1. va. gov/health/AboutVHA. asp US Department of Veteran Affairs. (2006). VA history. Www. va. gov updated February 9, 2006. Retrieved January 16, 2009 from http://www. va. gov/about_va/vahistory. asp Williams, M. (2004). Inadequate controls over the purchase card program resulted in improper and questionable purchases. Veterans Health Administration – Statement of the Financial Management and Assurance Director.

Healthcare and social support for the old and disabled US soldiers had been in place for centuries. However the Congress had formed the U. S Veterans’ Bureau only in 1921 with several beneficial programs aimed at veterans were drawn up …

The Veterans Health Administration (VHA) is currently our country’s largest integrated health care system (Oliver, 2007). It is a part of the Department of Veterans Affairs (VA) which was established in 1989 as a federal full cabinet department. Veterans’ health …

“The Veterans Health Administration: NSQIP Program” (Ball, Weaver, Kiel; 2004) was a physician-driven comparison study initiated by senior surgeons between 1991 and 1997, in which mortality and morbidity rates were “risk adjusted and compared to observed-to-expected ratios”. They studied data …

“The Veterans Health Administration: NSQIP Program” (Ball, Weaver, Kiel; 2004) was a physician-driven comparison study initiated by senior surgeons between 1991 and 1997, in which mortality and morbidity rates were “risk adjusted and compared to observed-to-expected ratios”. They studied data …

David from Healtheappointments:

Hi there, would you like to get such a paper? How about receiving a customized one? Check it out