VA Health Care:

Progress and Challenges in Providing Care to Veterans

T-HEHS-99-158: Published: Jul 15, 1999. Publicly Released: Jul 15, 1999.

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Pursuant to a congressional request, GAO discussed the Department of Veterans Affairs' (VA) new system for enrolling veterans for health care.

GAO noted that: (1) since implementing its enrollment system at the beginning of fiscal year (FY) 1999, VA has enrolled about 4 million veterans and its health care expenditures for these enrollees are on track with VA's projections; (2) however, each of the 22 Veterans Integrated Service Network (VISN) directors GAO surveyed told GAO that demand for care has increased in FY 1999 and that this increase has affected the delivery of timely care to veterans in some VISNs; (3) 80 percent of the directors GAO surveyed said that the waiting time to schedule primary and specialty care appointments has increased since the beginning of FY 1999; (4) while 21 of the 22 directors told GAO that enrollment was a factor to some extent in the increased demand, 13 cited the expansion of health care benefits and 12 cited additional VA outpatient clinics as other factors contributing to this increased demand; (5) 8 of the 22 VISN directors reported that VA's decision to open enrollment to all veterans has negatively impacted access to care for veterans in higher priority groups to some extent; (6) 9 told GAO that they had less than adequate capacity to meet the increased demand, and 3 directors chose to limit outreach efforts that would attract new veterans into the VA health care system; (7) this has created uneven access to care by making care available to veterans in some locations but not in others; (8) as VA nears its FY 2000 enrollment decision, VA's ability to continue its current level of care is unlikely, primarily because its FY 2000 budget request is based on an overly optimistic assumption that it will realize $1.4 billion in management efficiencies; (9) in prior testimony before the House Committee on Veterans' Affairs, Subcommittee on Health, some VISN directors stated that they will have difficulty achieving these management efficiencies; all of the 22 directors GAO surveyed told GAO that they anticipate having problems meeting veteran demand for health care in FY 2000; (10) if VA does not have the resources available to continue to enroll veterans in all priority groups in FY 2000, it will need to consider: (a) limiting health care eligibility to only those veteran priority groups or subgroups to which VA can provide timely care, as the act requires; (b) modifying the benefits it offers to all enrollees; or (c) both; (11) VA may have difficulty determining the financial effect of these options because its data on treatment costs and veteran income levels are insufficient; and (12) although VA has efforts under way to improve its data, it is unlikely that these improvements will occur in time for VA's FY 2000 enrollment decision.

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