Veterans' Health Care: Standards and Accountability Could Improve Hepatitis C Screening and Testing Performance

Three years ago, the Department of Veterans Affairs (VA) characterized hepatitis C as a serious national health problem that needs early detection to reduce transmission risks, ensure timely treatment, and prevent progression of liver disease. In a 1988 letter, VA outlined the process clinicians should use when (1) screening veterans for known risk factors for exposure to hepatitis C and (2) ordering tests to detect antibodies and diagnose hepatitis C infection as part of a plan to evaluate and assess risk factors for VA patients. This testimony discusses VA's progress in screening and testing veterans for hepatitis C during fiscal years 1999 and 2000. GAO found that VA missed opportunities to screen as many as three million veterans when they visited medical facilities during fiscal years 1999 and 2000, potentially leaving as many as 200,000 veterans unaware that they have hepatitis C infections. Of those screened, an unknown number likely remain undiagnosed because of flawed procedures. Although the pace of screening and testing appears to be improving, many currently undiagnosed veterans may not be identified expeditiously unless VA (1) establishes early detection of hepatitis C as a standard for care and (2) holds facility managers accountable for timely screening and testing of veterans who visit VA medical facilities.