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Without data on how long the delays were and what the cause of death was, it is impossible to tell if a delay contributed to a death or to increased morbidity. When the reported requirement to schedule a patient requesting an appointment within 14 days was implemented, what analysis was done to show that the VA facilities had the capacity to accomplish that metric? I would be surprised if the increase in veterans seeking care at a VA facility has been supported by an increase in providers commensurate with the increased demand. This is the same issue that the civilian world will be dealing with as a result of the Unaffordable Care Act.
We have the broad brush data for the U.S. healthcare system and need to burrow down and become more specific with VA healthcare. However, a close look at VA healthcare costs/resources compared to outcomes should be conducted alongside all other elements of the Medical-Industrial-Complex, which is untethered and out-of-control. I cite a study below to make my case; it’s time to pay closer attention to a national shame, with the lack of effective representation for citizens (not lobbyists) obviously a factor, and there has to be some combination of fraud, waste, and mismanagement on the one hand, with rampant and excessive profiteering on the other.
I don’t think I’m off track in looking at the broader picture; not when the rewards are much greater outside the VA system and where the context and situation can easily lead to slipshod and second rate inputs; human and material resources unable to compete in a more attractive and lucrative market seem to find their way into this VA mess we have on our hands. Not across the board, but often enough.
The OECD, using 2011 data, compared healthcare spending and healthcare outcomes in 34 developed countries. Only the United States produced exceptionally shocking and almost unfathomable results. Average at best in healthcare outcomes; one has to wonder, how does that square with our incredibly profligate spending? On a per capita basis, we spent two and one-half times the OECD average; as a percentage of GDP, we spent almost twice the OECD average. And in comparisons that frame the issue more clearly, it’s a shock when comparing our spending to the next most expensive national healthcare systems. On per capita spending, we are greater than 60% more expensive than ‘dead heat’ Norway and Switzerland, and as a percentage of GDP, our 18% of GDP compares very unfavorably with The Netherlands at 12% of GDP. We’re alone on cost and run of the mill on outcomes; in other words, we pay $3 trillion for a $2 trillion package of healthcare services.
I’m confident a detailed study would show that the number and length of delays, even ‘lost patients,’ would prove there’s an associated increase in morbidity. And it’s not really “the same issue that the civilian world will be dealing with.” Not when 151 VA hospitals are unable to flex and move to under-served areas; for example, the Phoenix VA ‘serves’ 85,000 veterans and you might as well pitch a tent when waiting is at least 90% plus of an average encounter there.
The increase in delay is a consequence to the increase in veterans requesting assistance which is a consequence to the increase of the US involvement in wars that don’t belong to us. Why are we fighting and getting involved in everybodies business when we are having our own problems? We will continue to have this problem as long as we keep sending our troops to wars that don’t affect us directly.
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Wright State University Boonshoft School of Medicine, Dayton, Ohio
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