Health Care Needs of Veterans in Puerto Rico and the Virgin Islands Should Be Assessed

HRD-78-84: Published: Mar 30, 1978. Publicly Released: Dec 3, 1982.

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The Veterans Administration's (VA's) furnishing of hospital care and medical treatment for nonservice-connected disabilities under contracts with private facilities and arrangements with private physicians in Puerto Rico and the Virgin Islands was reviewed. The review was directed toward: the use made of the VA's authority to provide medical treatment and hospital care for nonservice-connected disabilities under contractual arrangements with private facilities and physicians both prior to and following the enactment of Public Law 94-581, the justification which may exist for a special authority to provide such contract care and services, and the conditions which should be imposed on such an authority in the interest of equitable geographic allocation of VA resources.

Because the San Juan Veterans Administration hospital is operating at near capacity, the VA has made extensive use of the contract hospital program to provide inpatient care and has used the fee-basis program to provide outpatient care. Ineligible care is being provided under the fee-basis program as a result of not complying with the restrictions imposed on such care by P.L. 94-581. It is not clear whether the statutory limitation imposed on the use of contract hospitals is applicable to Puerto Rico and the Virgin Islands. Expansion of VA programs in Puerto Rico has primarily benefited veterans with nonservice-connected disabilities, and the expanded programs are not filled to capacity. There are indications that Puerto Rico and the Virgin Islands are getting a disproportionate share of VA resources; factors which contribute to this situation include location, lack of alternative VA facilities, social and economic problems, and a high incidence of mental disorders among the veteran population.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Administrator of Veterans Affairs should: implement the conditions imposed by P.L. 94-581 on the fee-basis outpatient program by not accepting any new patients who are ineligible for this care and terminating, as soon as possible, patients who are now receiving ineligible care; more closely monitor the fee-basis and contract hospital program to insure that veterans receive quality care and that the VA pays only for services received; perform audits of contract hospitals' cost reports within 90 days; and require any proposal from the San Juan VA hospital for additional beds to clearly demonstrate what impact such an addition would have on the contract hospital program.

    Agency Affected:


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