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 care was established around 1946, and was then known as the VA Department of Medicine and Surgery (Panangala, 2006). In 1989, it was taken over by the Veterans Health Services and Research Administration and was later renamed in 1991 to the Veterans Health Administration.
Since the mid 1990s, the VHA system has seen significant improvements with the level of care offered to the veterans than from what was previously provided by the VA (Longman, 2005). The nature of healthcare system offered by VHA is not of insurance types and neither does it provides for a pay-out but rather it provides direct service for military veterans through a nationwide network of government hospitals. The budget provided for health care is discretionary and not mandatory through federal government funding on a per annum basis.
The services provided through the VA hospitals and clinics are, in general, for all combat veterans and their dependents. The application or enrolment for healthcare eligibility and associated benefits is dependent on several factors which include nature of discharge from the military service, incurred disabilities or adjucated disabilities, income, assets and resources available. Initial application requires filling out of 10-10ez form and then the subsequent determination for veteran criterion and stratification into priority groups.
Yearly altercation of budget allocated for VA services set by the US Congress define the restriction for priority services for VA and as such, some veterans, especially those who belong to the higher income or, as the system denotes, Priority Group 8e and 8g, do not qualify for the full range of VA healthcare benefits. The single payer system does not only result to restricted enrolment but it can also lead to delays of receiving treatment and associated services (Bilmes, 2007). PROBLEM STATEMENT:
After serving the State and being discharged from the military service, what type of healthcare are the US veterans receiving? In 2006, there was an estimated 24 million living veterans of the U. S. military scattered throughout the United States with many of these service personnel having been discharged with adjucated disabilities and psychological trauma (Percy, 2007). The Veterans Health Administration provides health care service for US military veterans through numerous complexes of government hospitals, clinics, nursing homes, rehabilitation centers, and TRICARE beneficiaries.
The facilities, development of VA healthcare care service and their general availability do not reflect good status for the veteran beneficiaries and Percy (2007) estimated that 15 million veterans are not enrolled in the Department of Veterans Affairs health system. Such low statistical figure calls for determining the causality of the low-enrolment — obstacles prior to and during access of health care from the VA system, allocated budget pre-determined by the government, and over all satisfaction of the veterans with the healthcare service.
PURPOSE: The general objective of this study is to thoroughly examine the VA health care system, particularly those associated with routine utilization and extensive treatments. The study will also inspect the level of care provided for these veterans and the challenges faced with accessing care whether government or distance related. On the broader scope, it aims to assess the ‘quality’ of healthcare provided by the Veterans Health Administration (VHA) from the veteran’s perspective. SIGNIFICANCE:
Service members are linked by duty to the government and to the State and as such, the role of the government is to provide for pay, associated compensations, and retirement benefits for their military employs as dictated by the working contract and the Constitution. Health care is one of the benefits provided for the veterans and assessing the general ‘quality’ of the working public healthcare system, VHA, can reflect the general status of the mentioned system. The study focuses on systematic tracking of the management of veteran health and assessed it critically from the recipient’s perspective.
Such objective can provide for general insight, and process evaluation of the critical enrolment phase of VA healthcare system, and scope of health service. DEFINITIONS: VA — Veterans Administration—US government Department that overseas all veterans programs VHA— Veterans Health Administration—a department in the VA responsible for veteran’s health services CBOC—Community based outpatient clinics— clinics that are part of the VHA VAMC—Veterans Administration Medical Center – a hospital in the VHA VISNS—Veteran Service Integrated networks LITERATURE REVIEW:
The Veterans Health Administration (VHA) is divided into 21 Veterans Integrated Service Networks (VISNS) for veteran accession. Each individual network, oversee five to eleven hospital units, community–based outpatient clinics (CBOCs), nursing homes and counseling centers located within the geographic scope of individual VISNS. As of 2005, there were already 157 hospitals, 750 CBOCs, 134 nursing homes, 42 domiciliaries, 206 readjustment counseling centers and various other facilities (Panangala, 2006). In 2005, there were 7. 7 million enrolled veterans and 4.
8 million veterans received care. The VHA clinics outpatient clinics had more than 52 million veteran visits in 2005 (Percy 2007). The VHA criteria for care are dependent on various variables, which influences the type of service for which a veteran qualifies. These include things such as an type of discharge (e. g. honorable, dishonorable, other than dishonorable), length of service, presence of service connected disability, income levels and available VHA resources among others. Enrolment is a requirement before service accession and there is no set or imposed time for enrolment.
However, there are other clauses wherein enrolment is not necessary for health accession and the criteria for such event include the following: (1) If the veteran have a service-connected disability of 50% or more; (2) if the disability or injury happened or exacerbated in the line of duty and/or during a twelve month period following discharge; or (3) if the veteran wants medical care for a service connected disability only. Public Law 104-262 of the Veterans Heath Care Eligibility Reform Act of `1996 established a two-tier system for providing medical care.
Veterans are divided into one of two categories which dictate how the level of care is provided to them by the system. Under the VHA system, “eligible” meant the VHA “may” provide care and the term “entitled” meant the VHA must provide care. However, neither being eligible nor entitled to the services in the VHA, guaranteed that the health services were available through the working system. The funding for care in the VHA is set annually through the budget appropriated by the US Congress. When the funds are all exhausted, the VHA can not provide care to veterans even to those are entitled to it.
Veterans health funding are complicated issues which play significant role in the VA delivery of health care. In 2005 VHA admitted $1 billion deficiency in VA fiduciary. The VHA discretionary budget process has caused operational and financial problems that have a direct dramatic affect on veterans’ health care. Many of these issues came to the front 10 years after the Veterans Health Care Eligibility Reform Act of 1996. This rebuilt the VHA system that allowed for unprecedented growth in the demand for care for our nation’s veterans.
The total number of enrollees grew by almost 80% from 1999 to 2005 (Krugman, 2007). This problem was further exacerbated after the terrorist attacks in Sept of 2001wherein there were increased in military deployment services Afghanistan and Iraq. The war campaigns instigated by the State produced a new era of veterans which in turn created increased recipients for medical and health services thus putting enormous pressure on the VHA staff and funding (Bilmes, 2007). METHODS: This study will use survey to examine a veteran’s perspective of health care in the VHA system.
The surveys will be distributed to veterans of VFW Post # in Roseville Minnesota as well as veterans affiliated with veterans groups in Northern Minnesota and Illinois. They will also be distributed to single veterans who may or may not belong to any veterans group. Some of the veterans are close to a VAMC in Minneapolis, Minnesota, others have closer access to CBOCs in Illinois and some are far from either and have to depend on local transportation by the county or private transportation. The hope is to get a broader look at the veteran’s perspective of care in the VHA system.
We will use percentages as well as tables and graphs in analyzing the answers. A. Sample size determination? (type of sampling design? Sample size based on samplesize dermnation). B. Data gathering? (type of survey? Questionnaire contents? ) C Analysis?
References
Bilmes, Linda. (2007). Soldiers Returning from Iraq and Afghanistan: The Long-term Costs of providing Veterans Medical Care and Disability Benefits. Executive Summary. Kennedy School of Government. Harvard University. Retrieved on February 5, 2008 from www. epsusa. org/events/aea2007papers/bilmes.htm. Gao- 03-81st (2003, May). VA Long-Term Care: Veterans Access to non-institutional care is limited by Service Gaps and Facility restrictions. Retrieved on January 16, 2008 from www. gao. gov/htext/d03815t. html. Krugman, Richard, D. MD. (2007, October 18). Testimony presented in Congress on the House Committee on Veterans’ Affairs, Washington, D. C. Retrieved February 15, 2008 from http://veterans. house. gov/hearings/Testimony. aspx? TID=7730. Longman, Phillip. (2005). The Best Care Anywhere. Washington Monthly, Jan/Feb. Retrieved on