VA Health Care:

Resource Allocation Has Improved, but Better Oversight Is Needed

HEHS-97-178: Published: Sep 17, 1997. Publicly Released: Sep 17, 1997.

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Cynthia A. Bascetta
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Pursuant to a congressional request, GAO assessed the Department of Veterans Affairs' (VA): (1) implementation of the Veterans Equitable Resource Allocation System (VERA); (2) monitoring of changes in health care delivery resulting from VERA; and (3) oversight of the network allocation process used to give veterans equitable access to services.

GAO found that: (1) VERA shows promise for correcting long-standing regional funding imbalances that have impeded veterans' equitable access to services; (2) specifically, VERA allocates more comparable amounts of resources to the 22 networks for high-priority VA health service users--those with service-connected disabilities, low incomes, or special health care needs--than the resource allocation process it has replaced; (3) as a result, if fully implemented as planned, VERA could substantially shift funding among regions by fiscal year (FY) 1999; (4) in addition, VA continues to explore ways to improve VERA's capacity to more equitably allocate resources in the future; (5) among the improvements being considered are better measures of network workloads and adjustments for justifiable differences in network costs for providing health services; (6) although it is early in VERA's implementation, VA headquarters has not established an adequate monitoring system to identify changes in workload and medical practices that could negatively affect allocation equity and the appropriateness of care that veterans receive; (7) in addition, VA headquarters lacks the information to adequately review networks' planned facility services; (8) Veterans Integrated Service Networks (VISN) that GAO contacted are using varying methods to allocate resources to facilities; (9) for example, some VISNs allocate resources on the basis of the number of veterans using a facility; others negotiate changes in funding for programs or services from the preceding fiscal year to reach a new allocation; (10) VISNs, however, lack criteria on how to develop methods to give veterans equitable access; (11) to address these deficiencies, GAO has identified corrective actions for VA to take to enhance its ability to ensure that resources are allocated to improve veterans' equitable access to health care services and ensure that the care received is appropriate; and (12) these actions include improving the timeliness and thoroughness of overseeing changes in health care delivery resulting from the allocation process to the networks and to the facilities.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: VA has taken several steps to respond to this recommendation. As previously reported, VA monitoring of data showed that the number of one-time visits increased substantially in some VISNs after the implementation of VERA. To correct the impact on allocations, VA created a third capitation level of $100 for one-visit patients for fiscal year 1999. VA plans additional steps in 2000 to account for less expensive users of VA health care services. VA has also monitored special care population workloads under VERA to monitor the incentive to serve fewer less expensive patients. VA has found little change in these workload indicators and continues to monitor them. VA has not assessed potentially undesirable changes in medical care practices that could have resulted from VERA allocations.

    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to develop more timely and detailed indicators of changes in key VERA workload measures and medical care practices to maintain VERA's ability to equitably allocate resources in the future and help ensure that veterans receive the most appropriate care.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: VA revised its Directive 97-054 to its health care networks regarding their allocation of resources to facilities. The revision states that each network allocation model will support the goal of improving equitable access to care and ensure appropriate allocation of resources to meet that goal. This revision was incorporated into the directive in final on November 19, 1998. In addition, VA has been measuring clinic waiting times since February, 2000 and added more waiting time indicators in February, 2001 that provide information at the network and facility level. This provides VA information for use in assessing the impact of resource allocation on equitable access to care within and between networks.

    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to improve oversight of VISNs' allocation of resources to their facilities by: (1) developing criteria for use in designing VISN resource allocation methods; (2) reviewing and approving these methods; and (3) monitoring the impact of the methods on veterans' equitable access to care.

    Agency Affected: Department of Veterans Affairs


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