Ugly stories about waiting lists and poor care in VA facilities are coming out in the press. The VA’s head, Eric Shinseki has been run out of town. And investigations are underway into what’s going on and how to fix it.
The Wall Street Journal (Veterans Affairs Hospitals Vary Widely in Patient Care) used the VA’s internal data to compare the worst VA hospital (Phoenix) with the best (Boston) and to compare both with other VA hospitals that earn five stars. There are dramatic differences in areas like bloodstream infections and pneumonia rates and significant differences in death rates. The VA can and should use this information to share best practices, make improvements, reward those who do well, and weed out those who are not up to the task.
Waiting lists and uneven quality are a serious problem and they need to be addressed. These problems also play into an anti-Washington narrative about the poor quality and lack of accountability in government provided services compared to the private sector. I wouldn’t want to be treated at the Phoenix VA. Would you?
On the other hand, the Journal article points out that the VA measures and in some cases reports more on the performance of its hospitals than do private sector providers. In truth, there is not enough information to say whether the VA system is worse or better than the private system as a whole or even to compare the VA with individual private sector hospitals.
Some well regarded public sector providers in other parts of the world do a good job reporting on waiting times for appointments and procedures. See for example, the Waiting Times home page on England’s National Health Service website, which provides detailed, frequently updated statistics on waiting times.
Compare that with what we have in the US: a survey of physician practices taken a year ago in five specialties, conducted by a physician recruiting company looking for publicity. Even that survey shows we have serious problems. For example, in Boston it takes 10 weeks to get an appointment with a dermatologist or family doctor, we’re told. In a government run system like the VA or NHS, the public or elected officials can demand improvement. By contrast, who is going to force Boston doctors to see patients sooner?
June 4, 2014