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 and placed under the control of the newly formed Veterans Administration (VA). Subsequent to World War II, there was an increased need to rehabilitate nearly a million troops returning with physical and mental trauma. The Servicemen’s Readjustment Act of 1944 (Perlin, 2004) paved the way for setting a hospital system for the returning troops.
Veterans’ healthcare was then known as VA Department of Medicine and Surgery and later became Veterans Health Services and research Administration in 1989. It was in 1991 when it got its current name Veterans Health Administration (VHA). Today the VHA is a part of the Department of Veterans Affairs (VA) which was established in 1989 as a federal full-cabinet level department. The reputation of the veterans’ hospitals sunk to shockingly low levels in the mid-1990s. Decomposed bodies were found near its medical center in Salem.
Incompetent and uncaring staff, shortages of everything, rats and filth all around, malfunctioning equipment were all associated with the VHA. Politicians didn’t want to go against the unions of the VHA workforce and the veterans’ lobby. The Congress either wanted new hospitals built for the veterans or prevent old ones from being closed (Glabman, 2007). Three weeks before the 1996 election, President Bill Clinton signed a bill providing comprehensive healthcare to all veterans. Kenneth W. Kizer, the undersecretary for health and CEO of the VHA, undertook steps for the transformation of the VHA.
The Veterans Health Care Eligibility Reform Act of 1996 sought to restructure the hospital oriented system to a healthcare system, by incorporating services beyond hospital settings, ensuring appropriate resources and environments. A total of 22 geographically distinct service networks, the Veterans Integrated Service Networks (VISNs) were created. Today there are 21 networks with the merging of two of them. When the Congress opened up the healthcare system to all the 27 million veterans it was well received. However there was no appropriate funding to take care of the large influx.
The limitations of the system are evident from the Public Law 104-262 of the Eligibility Reform Act. Under this Act, veterans requiring healthcare are grouped into two, namely ‘eligible’ and ‘entitled’. As per the regulations ‘eligible’ means VHA may provide care, while ‘entitled’ meant VHA must provide care. But on the ground, neither was guaranteed of the services of VHA as VHA funding is set annually by the congress and when these funds are used up, care cannot be extended to anyone. The strain on VHA to cope up with healthcare demand is evident from the following statistics.
• The number of veterans requiring treatment each year rose 75% from 2. 8 to 4. 9 million between 1996 and 2003. • Despite the increase in the number of veterans requiring healthcare, the budget for treating them remained the same at $19 billion from 1995 to 1999. • In 2005 there were 7. 7 million enrolled veterans and 4. 8 million veterans who received care. • VHA itself admitted in 2005 that it was $1 billion short in its budget as the number of enrolled veterans grew by about 80% between 1999 and 2005 due to military deployment in Afghanistan and Iraq.
• In 2006 there was an estimated 24 million living veterans with roughly about 15 million veterans not enrolled with the Department of Veterans Affairs health system. Veteran’s healthcare involves a priority enrollment system based on certain criteria to determine their eligibility and the degree of coverage. Thus not all veterans may be eligible, and also this eligibility may vary from year to year depending on the funding of the VHA. Thus VHA had to ration healthcare in accordance with the funding provided by the congress (Longman, 2005). Under Kenneth W. Kizer, a turn around was achieved by the VHA
• There was a 25% decrease in per patient cost, in the first five years • The number of patients treated in 2006 doubled to 5. 2 million compared to 2. 7 million in 1994. • The cost of treatment per patient declined to $4,092 in 2006 compared to $5,691 in 1995, after adjusting for inflation. • Hospital admissions reduced by about 36% while 55% of acute care hospital beds were closed. Today it provides direct healthcare at a fairly good level for the discharged veterans with telemedicine, web-based decision support systems and several such systems in place. The number of outpatient clinics had been increased by four folds.
Research has also become integral to the VA with about $400 million of its budget allocated for research. There are about 10,000 current research projects carried out at more than 100 VA centers (Ericksen, 2008). As a result of many such initiatives, the quality of VHA healthcare improved considerably and costs reduced as seen above.
REFERENCES
Perlin B Jonathan (2004) The Veterans Health Administration: Quality, value, accountability, and information as transforming strategies for patient-centered Care The American Journal of Managed Care Vol. 10:828-836. Nov. 2004 [Electronic Version] downloaded on 19th October 2008 from http://www.
ajmc. com/Article. cfm? ID=2767 Ericksen B Anne. (2008) Veterans affairs nursing in the 21st century. [Electronic Version] downloaded on 19th October 2008 from http://www. minoritynurse. com/features/nurse_emp/05-04-05d. html Longman P (2005) The best care anywhere. [Electronic Version] downloaded on 19th October 2008 from http://www. washingtonmonthly. com/features/2005/0501. longman. html#byline Glabman Maureen (2007) Health plans can learn from VHA turnaround. [Electronic Version] downloaded on 19th October 2008 from http://www. managedcaremag. com/archives/0702/0702. veterans. html