The Department of Veterans Affairs (VA) operates one of the largest health care systems in the nation. For fiscal year 2007, VA estimates that it will provide health care to more than 5 million veterans, either in its own facilities or through other health care providers. During the past decade, the numbers of VA patients and the costs for treating them have increased rapidly, due in part to an expansion in the number of veterans eligible to receive care. The Veterans Health Administration (VHA)--the VA entity responsible for the health care of veterans--spends about $35 billion a year providing health care to veterans, including more than $7 billion to acquire health care services and products. In its own health care facilities, VHA contracts for a broad range of medical services such as anesthesiology, for other services that support the delivery of medical care such as facility maintenance and laundry services, and for products such as medical equipment, food, and hospital linens. It also contracts for medical care for veterans provided in non-VA hospitals and community based clinics. Contracting for services at VHA represents a large and growing proportion of total contract spending. In an effort to improve the operation of VHA's health care system, VA's Inspector General (IG) conducted reviews of individual VHA facilities through structured site visits with teams of IG officials from fiscal year 1999 through fiscal year 2006. These teams included officials from three IG offices--Audit, Health Care Inspections, and Investigations. These reviews, known as the Combined Assessment Program (CAP), focused in part on actions to increase the efficiency and effectiveness of VHA's contracting. The IG issued a summary report in September 2006 on the results of these CAP reviews, including summaries of recommendations made to address systemic, recurring deficiencies in the planning, management, and oversight of service contracts. In addition the IG issued other reports in recent years on weaknesses in VHA health care contracting. Congress requested that GAO review the recommendations made by the VA IG to improve the award and administration of service contracts for veterans' health care, and VA's efforts to implement these recommendations. In this report GAO identifies (1) the recurring themes among the key recommendations from recent reports of the IG concerning VHA's award and administration of service contracts for veterans' health care, and (2) the current status of VHA's implementation of the recommendations, according to VA data.
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