Did We Improve Veterans Health Care? It's Unclear


(U.S. News & World Report)

Veterans waiting for their appointments at the VA Medical Center in El Paso, Texas

Photo by Ivan Pierre Aguirre/Reuters

by Carrie M. Farmer and Susan D. Hosek

May 24, 2016

Once again, waiting times encountered by veterans at Veterans Affairs medical facilities are in the news. Back in the summer of 2014, in response to media reports of veterans facing long wait times for health care, Congress passed the Veterans Access, Choice and Accountability Act of 2014. At the heart of the legislation was a program allowing veterans with poor access to care in VA facilities the option of receiving health care in the private sector. The Veterans Choice program, as it is called, was intended to serve as a release valve to relieve pressure on the VA system and expedite veterans' access to care.

Congress is now considering the future of the Veterans Choice program, including whether to make it permanent and expand eligibility to all veterans enrolled in VA health care. Yet, little is known about this program's potential as a long-term supplement to the care VA provides and its effectiveness as a solution to ensure timely access to care for veterans.

Under current law, veterans who live far from a VA facility and those waiting longer than 30 days for an appointment are eligible for the Veterans Choice program. Most veterans who do not live near VA facilities live relatively close to a primary care provider in their community. However, those who live far from VA facilities and need specialty care are less likely to find specialty care closer to home. For example, our research has shown that only 35 percent of veterans living far from VA facilities live within 40 miles of a private sector oncologist, meaning that veterans with cancer who live far from VA are more likely than not to live far from the care they need, regardless of who provides that care. Whether the Veterans Choice program increases access for veterans living in rural and remote areas, especially for those in need of specialty care, is unknown.

To our knowledge, there has been no systematic analysis of the timeliness of care veterans receive through the Veterans Choice program, but recent media reports suggest that veterans are still facing significant waits for care. Recently, NPR reported that some veterans were experiencing long delays and difficulties making appointments for care in the private sector as well. This is not surprising. A 2013 study (PDF) of private-sector health care wait times in 15 major metropolitan markets assessed the average number of days between the initial call to make a new patient appointment and the appointment date. Across these markets, the average wait time for an appointment with a family physician was 19.5 days. A similar 2013 study in Massachusetts reported average waits of 39 days between the initial call to make a new patient appointment and the appointment date for family medicine, 50 days for internal medicine and between 22 and 37 days for specialty appointments. Ensuring that veterans receive timely appointments in the private sector when they cannot access care at a VA facility may require some changes in the identification and referral of private sector providers. Data showing how often and why veterans using the Veterans Choice program experience delays in getting community care would allow the VA and Congress to identify needed changes in the program.

Information on the quality of care delivered through the Veterans Choice program is also missing. That the VA performs as well or better than the private sector on most measures of health care quality has been well-documented in numerous studies, including our own. What is unknown is whether veterans receiving care through Veterans Choice receive care that meets these high standards. Relatedly, there has been no systematic assessment of veterans' experience with Veterans Choice and the care they receive from Veterans Choice providers.

More information is needed about the impact of the Veterans Choice program. The VA should monitor and report the timeliness and quality of care veterans receive through Veterans Choice to ensure that this care meets the standards VA has set for itself. America's veterans deserve the best care possible. Before making this program permanent, the VA should better understand its effectiveness, or risk jeopardizing its promise to care for those who have served their country.

Carrie Farmer is a senior policy researcher and associate director for the Behavioral and Policy Sciences Department at the nonprofit, nonpartisan RAND Corporation. Susan D. Hosek is a member of the RAND adjunct staff and a professor at the Pardee RAND Graduate School.

This commentary originally appeared on U.S. News & World Report on May 24, 2016. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.