Introduction
The United States has engaged in military conflict in many war zones throughout the last several decades. In addition to surviving the combat, a veteran must also deal with some unique health complications and hazards that exist in the armed forces. To that end, the Veterans Health Administration was established, which is supposed to provide healthcare benefits to discharged military personnel. However, there is evidence to suggest that the veterans’ healthcare system has some flaws that result in delayed healthcare, limited options, and even deaths.
Veterans Health Administration is a part of the more extensive American healthcare system, which itself is in dire need of reform. This policy analysis will attempt to identify alternatives to the existing veterans’ healthcare policy and evaluate them in terms of making healthcare more accessible.
Background
Combat veterans suffer from many unique health issues that require high-quality healthcare. The current policy is for the veterans to receive healthcare in VHA-affiliated medical facilities, according to their Priority Group, or in other VA-contracted facilities. These groups are calculated using several metrics, such as income, service record, or health conditions received during service (O’Shea, 2016). For the most part, the quality of the care itself appears to be on par with or higher than in non-VA medical facilities (O’Hanlon et al., 2016).
The veterans that undergo treatment in these facilities receive the care of the highest possible standard in the nation if the VHA reports are to be believed. The problem is those that do not make it into the facility due to VHA’s systemic flaws. The exact scope of the problem is unknown because reliable data is only available for the patients that were received by the system.
There are, however, many patients that do not receive the care they require and perish before they are admitted. Some claim that approximately 238,000 veterans died due to significant delays (O’Shea, 2016). There exist secret waiting lists that are not reported to the public to hide the actual waiting times and uphold the image of the VHA. The financial incentives from the state are likely to encourage the medical facilities to obfuscate numbers on official documents, while real veterans die (Fulton & Brooks, 2018).
The existing policy is further exacerbated by a new government contract between VA and Optum, which is likely to limit access to healthcare further (Scott, 2019). The new plans cut costs for the state, but create a smaller network of affiliated professionals to the patients. While the current policy serves the interests of the Optum beneficiaries, the primary stakeholders, the veterans, will continue to die. Other stakeholders include veterans’ groups, hospitals, insurance firms, pharmaceutical companies, and both of the political parties.
Analysis
The change in policy concerning this issue should result in more patients being able to get the help they need at lower costs and higher quality. The possible solutions, as offered by Fulton and Brooks (2018), are the VHA-only solution, the CMS takeover, the TRICARE integration, and the status quo. All these solutions are aimed at making insurance available, as affordable healthcare was shown to be the most effective at improving outcomes (Sommers, Gawande, & Baicker, 2017).
The VHA-only solution entails allocating more money towards VA, constructing more healthcare facilities, and hiring more staff. Currently, the veterans have access to other medical facilities that are contracted by the VHA, but the VHA-only solution would prohibit that access. The policy would not address the structural flaws in the existing system and would require large sums of money that are not guaranteed to be used efficiently. Of all the possible solutions, this one would negatively impact veterans the most.
The CMS takeover would gradually shift veterans into Medicare-affiliated hospitals and finance that care through CMS’ Medicare process. The organization would acquire the already-existing VA-affiliated hospitals. The cost-effectiveness and out-of-pocket price of this solution are unknown, but the veterans would receive access to all Medicare facilities in America, increasing choice. However, that would mean the privatization of veterans’ healthcare, which is not politically attractive. This system operates within Medicare, which means non-Medicare hospitals would place high costs on veterans.
The TRICARE solution would expand the subsidized insurance of the Department of Defence to veterans. This solution is cost-effective, and the patient experiences of those enrolled in the TRICARE programs are high. However, consolidating all healthcare under DoD is a threat to the existence of VHA, which is politically unfavorable. The system also requires veterans to pay, which is problematic, as the entire point of the solution is to make healthcare affordable.
Finally, upholding the status quo is only superior in terms of cost efficiency and healthcare quality to a VHA-only solution, and is inferior to CMS and TRICARE. However, it is the most politically favorable one. All of the existing flaws would remain, and the primary beneficiaries of the system would receive sub-standard care. The status quo is only viable if the VHA continues to contract medical facilities, which remains its primary advantage over a VHA-only solution.
However, as these solutions are rooted in the existing system, they do not address the underlying systemic flaws. The reason why veterans require VA-affiliated hospitals is that they often cannot afford treatment in a regular hospital that is out of their network and the high insurance premiums, deductibles, and other out-of-pocket costs (Warren, 2019). A fifth alternative policy would be single-payer state-sponsored healthcare that would cut insurance companies’ and hospitals’ influence on prices.
The veterans would be able to afford their healthcare, as theirs will be subsidized to the same degree as everyone else’s. However, that solution is a complex and long-term change to the federal policy. It is also exceptionally politically unfavorable and would lead to unpredictable shifts in the market. In the short term, the upheaval of the healthcare industry could lead to decreased standards of care and financial losses.
Recommendations
The privatization of VHA under CMS would be the most beneficial solution, as it would open access to numerous Medicare-affiliated facilities. The specific policy should include broad cost-cutting measures to keep the out-of-pocket fees as low as possible.
All the other solutions provide fewer options to the veterans and are too dependent on the ineffective bureaucracy of the VHA. This solution is aimed at the financial and administrative branch of the healthcare system, and its effect on actual clinical practice should be minimal. With that in mind, this analysis only took the data from academic and media sources, which may not reflect the real state of affairs in the hospitals. The data that the VHA provides may not be accurate, but if that is the case, then all the more reason for comprehensive reform.
Conclusion
The health of a veteran has become the responsibility of the Veterans Health Administration to help them find affordable and effective care. However, there exist severe systemic problems that have caused numerous deaths due to misreporting and obfuscation of truth. While a radical reform of the American healthcare system would help the veterans get the help they deserve, a less global solution would be to privatize the veterans’ healthcare. The Medicare-affiliated hospitals would become available to them, expanding their options, and the solution may prove to be more cost-effective.
References
Fulton, L., & Brooks, M. (2018). An evaluation of alternatives for providing care to veterans. Healthcare, 6(3), 92.
O’Hanlon, C., Huang, C., Sloss, E., Anhang Price, R., Hussey, P., Farmer, C., & Gidengil, C. (2016). Comparing VA and non-VA quality of care: A systematic review. Journal of General Internal Medicine, 32(1), 105–121.
O’Shea, J. (2016). Reforming veterans health care: Now and for the future. Web.
Scott, D. (2019). Trump’s big veteran’s health care plan has hit a snag. Web.
Sommers, B. D., Gawande, A. A., & Baicker, K. (2017). Health insurance coverage and health — what the recent evidence tells us. New England Journal of Medicine, 377(6), 586–593.
Warren, E. (2019). Ending the stranglehold of health care costs on American families. Web.