Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

Hussey, Peter S.; Ringel, Jeanne S.; Ahluwalia, Sangeeta C.; Price, Rebecca Anhang; Buttorff, Christine; Concannon, Thomas W.; Lovejoy, Susan L.; Martsolf, Grant R.; Rudin, Robert S.; Schultz, Dana; Sloss, Elizabeth M.; Watkins, Katherine E.; Waxman, Daniel A.; Bauman, Melissa D.; Briscombe, Brian; Broyles, James R.; Burns, Rachel M.; Chen, Emily K.; DeSantis, Amy Soo Jin; Ecola, Liisa; Fischer, Shira H.; Friedberg, Mark W.; Gidengil, Courtney A.; Ginsburg, Paul Β.; Gulden, Timothy R.; Gutiérrez, Carlos Ignacio; Hirshman, Samuel; Huang, Christina Y.; Kandrack, Ryan; Kress, Amii M.; Leuschner, Kristin J.; MacCarthy, Sarah; Maksabedian, Ervant J.; Mann, Sean; Matthews, Luke J.; May, Linnea Warren; Mishra, Nishtha; Miyashiro, Lisa; Muchow, Ashley N.; Nelson, Jason; Naranjo, Diana; O’Hanlon, Claire E; Pillemer, Francesca; Predmore, Zachary; Ross, Rachel; Ruder, Teague; Rutter, Carolyn M.; Uscher‐Pines, Lori; Vaiana, Mary E.; Vesely, Joseph V.; Hosek, Susan D.; Farmer, Carrie M.

doi:10.7249/rr1165.2

2015

DOI: 10.7249/rr1165.2

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Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

Peter S. Hussey¹,

Jeanne S. Ringel²,

Sangeeta C. Ahluwalia³

et al.

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Cited by 19 publications

(8 citation statements)

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“…4 Increased access to CC has the potential to benefit rural Veterans in particular, who often face obstacles obtaining care at VHA due to greater geographic and distance barriers, hospital closings, and provider shortages. 5,6 For these reasons, rural Veterans have historically relied more heavily on non-VHA care than their urban counterparts. 7 To help address the unique needs of rural Veterans, VHA undertook several initiatives: the Office of Rural Health was established in 2006; Community-based Outpatient Clinics were implemented in rural areas; reimbursements were allotted to Veterans for travel to VHA facilities for care; and investments were made in telehealth services to rural Veterans.…”

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confidence: 99%

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Did Access to Care Improve Since Passage of the Veterans Choice Act?

et al. 2021

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confidence: 99%

“…Increased access to CC has the potential to benefit rural Veterans in particular, who often face obstacles obtaining care at VHA due to greater geographic and distance barriers, hospital closings, and provider shortages 5,6. For these reasons, rural Veterans have historically relied more heavily on non-VHA care than their urban counterparts 7.…”

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confidence: 99%

Did Access to Care Improve Since Passage of the Veterans Choice Act?

et al. 2021

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“…A recent RAND Corporation study found that veterans living more than 40 miles from a VA facility often did not live any closer to civilian psychiatrists and psychologists. 4 Therefore, allowing those vet-VIEWPOINT…”

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confidence: 99%

“…Despite these laudable efforts, the VA is often challenged to fill these positions and retain health care professionals owing to perceived deficiencies, such as relatively low compensation, high workload, and lack of managerial support. 4 In a recent RAND Corporation report, administrators consistently named workforce shortages as the number one source of delays in care for veterans with posttraumatic stress disorder. 4 Other reports point to this and other workforce challenges to providing care for veterans with service-related behavioral health conditions.…”

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confidence: 99%

“…4 In a recent RAND Corporation report, administrators consistently named workforce shortages as the number one source of delays in care for veterans with posttraumatic stress disorder. 4 Other reports point to this and other workforce challenges to providing care for veterans with service-related behavioral health conditions. 6 Although the VA should continue to work to hire more behavioral health professionals, it must simultaneously pursue workforce solutions that do not rely on simply increasing the number of health care professionals.…”

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confidence: 99%

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Behavioral Health Workforce and Private Sector Solutions to Addressing Veterans’ Access to Care Issues

2016

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Behavioral health conditions pose a significant burden on the health and well-being of American veterans. Service-related behavioral health conditions, such as posttraumatic stress disorder, are especially prevalent and cause significant disability. In recent months, new concerns have been raised about whether the Veterans Health Administration can adequately address the challenges in meeting the need for veterans' care, especially in behavioral health. 1 Concern in policy circles is running high about systemic issues within the Department of Veterans Affairs (VA) system that may limit veterans' access to behavioral health care.To address this issue, policymakers are proposing a range of policy solutions. Many of these solutions include allowing veterans to seek care from private sector health care professionals (eg, psychiatrists, psychologists, and social workers). In 2014, President Obama signed into law the Veterans Access, Choice, and Accountability Act (hereafter referred to as the Veterans Choice Act). As part of this act, the VA was given increased funding to purchase care in the private sector for veterans with poor access to care in VA facilities. Most recently, the Commission on Care, a "blue-ribbon" panel required by the Veterans Choice Act to study the future of the VA health care system, suggested transforming the VA into an integrated care system that is part provider and part payer for private sector care, emphasizing the veteran's choice of where to receive care. 2 Other proposed solutions from policymakers and presumptive presidential candidates focus on improving a veteran's access to private sector providers.Despite growing political support and legislative demand for such private sector solutions, there is reason to believe that the current civilian behavioral health workforce is not fully equipped to meet the unique behavioral health care needs of the veteran population, especially those with service-related conditions. Policymakers must be mindful of the challenges already facing the private sector behavioral health workforce when proposing aggressive private sector solutions to strengthen veterans' access to behavioral health care.Nearly all published and anecdotal evidence suggests thatthereisasignificantshortageofbehavioralhealthprofessionals across the United States. 3 Furthermore, these shortages are not evenly distributed across the population, with particular shortages in rural areas. Shortages of behavioralhealthprofessionalsinruralareasaffecttheveteran population severely. A recent RAND Corporation study found that veterans living more than 40 miles from a VA facility often did not live any closer to civilian psychiatrists and psychologists. 4 Therefore, allowing those vet-VIEWPOINT

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Priority access to health care: Evidence from an exogenous policy shock

et al. 2020

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Access to care is an important issue in public health care systems. Unlike private systems, in which price equilibrates supply and demand, public systems often ration medical services through wait times. Access that is given on a first come, first served basis might not yield an allocation of resources that maximizes the health of a population, potentially creating suboptimal heterogeneity in wait times. In this study, we examine an access disparity between two groups of patients-established patients and new patients. We exploit an exogenous policy change-implemented by the U.S. Veterans Health Administration-that removed the disparity and homogenized the wait time.We find strong evidence that without such a policy, established patients have priority access over new patients. We discuss whether this is a suboptimal allocation of resources. We additionally find that established patient priority access is an important determinant of access for new patients; accounting for it increased the explanatory power of our statistical model of new patient wait times by a factor of five. The findings imply that policy and management decisions may be more effective in achieving the optimal distribution of access if access heterogeneity is recognized and accounted for explicitly. K E Y W O R D Saccess to care, prioritization, public health care, resource allocation, wait time

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Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

Cited by 19 publications

References 223 publications

Did Access to Care Improve Since Passage of the Veterans Choice Act?

Did Access to Care Improve Since Passage of the Veterans Choice Act?

Behavioral Health Workforce and Private Sector Solutions to Addressing Veterans’ Access to Care Issues

Priority access to health care: Evidence from an exogenous policy shock

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