VA Health Care:

Variabilities in Outpatient Care Eligibility and Rationing Decisions

HRD-93-106: Published: Jul 16, 1993. Publicly Released: Jul 22, 1993.

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Pursuant to a congressional request, GAO provided information on veterans' access to Department of Veterans Affairs' (VA) outpatient care, focusing on how VA: (1) determines veterans' eligibility for outpatient care; and (2) rations care when resources are insufficient to serve all eligible veterans.

GAO found that: (1) veterans' access to outpatient care at VA medical centers varies because medical centers interpret VA eligibility criteria differently and make rationing decisions on an individual basis; (2) the need for hospitalization is difficult to determine, since interpretations of statutory outpatient eligibility criteria depend upon physicians' subjective judgments; (3) 118 VA medical centers rationed veterans' discretionary outpatient care in 1991 to varying degrees; and (4) the VA medical centers that ration care make their rationing decisions based on income levels, medical service, and the type of medical condition, resulting in veterans with similar medical conditions receiving different levels of care.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: The House VA Committee has acknowledged that eligibility reform of VA health-care is a priority agenda item. In July 1995, VA presented its proposed eligibility reform legislation. Congress, however, has not indicated an intention to direct the Secretary of Veterans Affairs to develop a better resource allocation method as part of VA's overall eligibility reform initiative.

    Matter: If Congress prefers that the current priorities for discretionary outpatient care be implemented consistently on a systemwide basis, it should direct the Secretary of Veterans Affairs to develop a different system for allocating its resources to the medical centers so that veterans within the same priority categories, to the extent practical, receive access to discretionary outpatient care at each medical center.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: VA presented its legislative proposal to reform eligibility for the Department of Veterans Affairs health-care benefits to the House Committee on Veterans' Affairs in July 1995.

    Recommendation: The Secretary of Veterans Affairs should either: (1) develop and propose to Congress alternative eligibility criteria that produce greater consistency among medical centers in eligibility determinations; or (2) provide better guidance to centers so that clinicians may achieve more consistent determinations when interpreting the current criteria.

    Agency Affected: Department of Veterans Affairs


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