Come Saturday Morning: Best Care Anywhere
Yesterday our own DSWright passed along a US News story making its way around the conservative media sites on how some of the pricier hospitals in the US may be choosing to refuse people with Obamacare insurance, much as they and their doctors currently reject people on Medicare. (Which is silly: If they’ve signed the provider contracts with the health care exchanges, they are committed to providing care, period. No take-backsies.)
This reminded me of two points: one, that the US health care system overall produces worse outcomes (and for more money) than any other system in the developed world, and two, that the best health care in the United States comes not from any of the fancy-dancy expensive hospitals usually considered our “best”, but from the hospitals run by the Veterans Administration. The first point is well known by most well informed people; the second is not, yet it’s been the case ever since President Clinton did a major, and genuine, reform of the Veterans Hospital Administration nearly twenty years ago.
Here’s Philip Longman writing in 2005 on the VA’s superior performance:
Who do you think receives higher-quality health care. Medicare patients who are free to pick their own doctors and specialists? Or aging veterans stuck in those presumably filthy VA hospitals with their antiquated equipment, uncaring administrators, and incompetent staff? An answer came in 2003, when the prestigious New England Journal of Medicine published a study that compared veterans health facilities on 11 measures of quality with fee-for-service Medicare. On all 11 measures, the quality of care in veterans facilities proved to be “significantly better.”
Here’s another curious fact. The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care.
It gets stranger. Pushed by large employers who are eager to know what they are buying when they purchase health care for their employees, an outfit called the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA’s seal of approval is the gold standard in the health-care industry. And who do you suppose this year’s winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.
Not convinced? Consider what vets themselves think. Sure, it’s not hard to find vets who complain about difficulties in establishing eligibility. Many are outraged that the Bush administration has decided to deny previously promised health-care benefits to veterans who don’t have service-related illnesses or who can’t meet a strict means test. Yet these grievances are about access to the system, not about the quality of care received by those who get in. Veterans groups tenaciously defend the VHA and applaud its turnaround. “The quality of care is outstanding,” says Peter Gayton, deputy director for veterans affairs and rehabilitation at the American Legion. In the latest independent survey, 81 percent of VHA hospital patients express satisfaction with the care they receive, compared to 77 percent of Medicare and Medicaid patients.
Outside experts agree that the VHA has become an industry leader in its safety and quality measures. Dr. Donald M. Berwick, president of the Institute for Health Care Improvement and one of the nation’s top health-care quality experts, praises the VHA’s information technology as “spectacular.” The venerable Institute of Medicine notes that the VHA’s “integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation.”
That was in 2005. Has anything changed in the past eight years to change Longman’s mind? Nope — he still says, and experts agree, that the VA still provides the true gold standard for patient care in the United States.
It’s true: When it comes to the US of A, the VA hospital system really does provide the Best Care Anywhere.