Précis This!

Veterans Administration Outperformed Other Health Care Systems, 2005 Analysis Found August 18, 2009

Update: March 17, 2010 — Updated OECD data located here.

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Updated September 29, 2009, to include Tables 1 (medical conditions examined) and 2 (quality indicators examined).

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A popular mantra in the United States is that government-run health care would be a disaster because “it’s government.”

Setting aside the U.S. single-payer Medicare system, what if the U.S. government really did run a health care system top to bottom?  Surely that would be the greatest test of government performance?

Rummaging the data mines I was startled by a research summary I found at RAND Corporation, the research and policy think tank founded in Santa Monica, California, in 1948.

Researchers examined 294 quality measurements at the Veterans Health Administration, comparing patient medical records with those in a national sample. The result, RAND reported in a research bulletin, was that “VA patients were more likely to receive recommended care than patients in the national sample,” and with a better outcome.  In fact, the VA outperformed the national sample in all but one category of patient care delivery.

VA patients received about two-thirds of the care recommended by national standards, compared with about half in the national sample.

The greatest differences between the VA and the national sample were for indicators where the VA was actively measuring performance and for indicators related to those on which performance was measured.

Quality of care for acute conditions—a performance area the VA did not measure—was similar for the two populations.

VA patients received consistently better care across the board, including screening, diagnosis, treatment, and follow-up.

For preventive care, the difference was greater: VA patients received about 65 percent of recommended care, while patients in the national sample received 20 percent less.

Among chronic care patients, VA patients received about 70 percent of recommended care, compared with about 60 percent in the national sample.

(Bold emphasis added.)

I checked the researchers’ article in Annals of Internal Medicine against RAND’s summary of the results, and created the charts below from a table in RAND’s summary.  The charts clearly show the VA scoring higher in all categories except acute care (Chart 4), where the VA scored two points below the national sample.

Medical Conditions and Quality Indicators Examined

Source: Annals of Internal Medicine

Policy Question and Comment

If the question in America’s current health care debate is whether the federal government can run an effective national health care system, this study suggests the answer could be “yes.”

Anecdotally, I live in Canada, which has a “blended” universal health care system in which government seems to achieve the same overall results — or better — than the U.S. model. In the Canadian system the government covers about 70% of health care costs at about 10% of GDP, compared to the U.S. system, which reportedly covers 46% of costs at more than 16% of GDP (2009).  I’ve been reading and comparing data on the health care systems of the U.S., Canada and other OECD countries for a couple of months. That has been eye-opening for me, too. More on that later.

Sources

——. Improving Quality of Care; How the VA Outpaces Other Systems in Delivering Patient Care. RAND Health, Research Highlights, RB-9100, 2005.  Available at www.rand.org/health

Asch, Steven M., Elizabeth A. McGlynn, Mary M. Hogan, Rodney A. Hayward, Paul Shekelle, Lisa Rubenstein, Joan Keesey, John Adams, and Eve A. Kerr, “Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample,” Annals of Internal Medicine, Vol. 141, No. 12, December 21, 2004.