The struggle for health equity: the sustained effort by the VA Healthcare System.

Abstract

The Veterans Health Administration is the largest integrated health care system in the United States, established in 1930 by the Roosevelt administration to “consolidate and coordinate government activities affecting war veterans.” Even though the Department of Veterans Affairs (VA) has historically struggled to provide high quality medical care,1 and is currently facing highly publicized challenges in ensuring timely veteran access to health care, studies document remarkable strides in delivery of high quality health care in the VA relative to the private sector.2–5 For example, diabetes care in the VA is superior to that provided in the private sector,4 and VA patients are more likely than Medicare patients to receive life-saving cardiac care.5 VA performance on many process-of-care quality measures across the full spectrum of health care services (prevention, screening, diagnosis, treatment, and follow-up) is better than in non-VA health care systems.2 Finally, veterans report higher levels of satisfaction with VA health care than their counterparts receiving care in the private sector.6 This progress is driven by the VA’s emphasis on patient-driven, proactive, personalized health care and its sustained commitment to equitable delivery of high quality health care to all veterans, including those most vulnerable for disparities in health care and health outcomes (i.e., historically underserved veterans [e.g., women, racial and ethnic minorities, rural residents], veterans with permanent disabilities, cohorts with shared military experience, and veterans whose living arrangements pose special challenges to their health or health care delivery [e.g., homeless]). This commitment to equity is evident in the preponderance and diversity of research and quality improvement initiatives focused on vulnerable veteran populations, in dedicated VA offices charged to ensure the equity of VA health care and services, in publicly reported data on patient health care experiences stratified by race and gender, and in VA’s primary care delivery model that uses strategies effective in reducing disparities. VA health care delivery is supported by centralized administration; a high value, evidence-based pharmacy benefits plan; and a national health information technology platform that enables innovative and interactive use of the electronic health record and clinical and administrative data for intervention, evaluation, and tracking of patient care. These unique assets secure VA’s position as an industry leader in today’s health care market, despite the challenges it faces in ensuring timely access to high quality, equitable health care for all veterans.