VA Health Care:

Improving Veterans' Access Poses Financial and Mission-Related Challenges

HEHS-97-7: Published: Oct 25, 1996. Publicly Released: Oct 25, 1996.

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Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) efforts to establish health care access points to provide outpatient care for veterans who are geographically distant from VA hospitals.

GAO found that: (1) the new access points represent a proactive effort to transition from a direct delivery system to an integrated network of VA-operated hospitals and VA and non-VA outpatient providers; (2) VA ignored statutory limitations in its legal authority to provide primary care to veterans, but legislation has been enacted which expands VA authority to contract for the provision of such care and veterans' eligibility to receive such services; (3) VA hospitals must finance access points within their existing budgets, which will generally require reallocating resources among current activities and services; (4) although access points should in time allow VA hospitals to serve current users more efficiently, the efficiencies may not generate enough savings to offset the increased costs associated with caring for increased numbers of veterans who may use the new clinics; and (5) because VA has not developed a strategic plan for expanding veterans' access to its medical care system, it is difficult to accurately gauge the number of access points VA will need or the effect they will have on the VA mission.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: VA has addressed the recommendation by incorporating in its VHA Directive 96-049 (August 7, 1996) that Veterans Integrated Service Networks (VISNs) locate access points (clinics) "generally within 30 minutes travel time."

    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to establish a travel time or distance standard to be followed by VA hospitals as they plan for additional access points in their service areas.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: VA has addressed Part 1 of the recommendation by incorporating in its VHA Directive 96-049 (August 7, 1996) that Veterans Integrated Service Networks (VISNs) locate access points (clinics) "generally within 30 minutes travel time." In response to Part 2, VA has restated its intentions to serve "existing patients" and new users "within existing resources and treatment priorities."

    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to require VA hospitals to establish their access points in a manner that focuses on the: (1) equalization of access for current users of the VA health care system on the basis of the designated time or distance standard; and (2) enrollment of any new users of the system in accordance with statutory priorities for VA care.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: VA does not agree that it is necessary to provide Congress with a report solely on VA's overall plans for systemwide establishment of access points. VA has completed an analysis that shows that 14 percent of veterans nationwide live further than 30 miles from a VA facility (VA's access standard). VA issued a Strategic Plan that calls for improved and more convenient access for patients through the opening of more community based outpatient clinics. This plan, however, provides no details regarding cost and affordability or the impact on veterans' access to care.

    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to provide Congress a report that presents the overall VA plan and time schedule for the systemwide establishment of access points to assist Congress in determining the affordability of the VA plan.

    Agency Affected: Department of Veterans Affairs

 

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