Veterans’ Care: The Author Replies

Abstract

Letters Health AffairsVol. 37, No. 4: Culture Of Health, The ACA & More Veterans’ Care: The Author RepliesRisha Gidwani-Marszowski AffiliationsVA Health Economics Resource Center Menlo Park, CaliforniaPUBLISHED:April 2018Free Accesshttps://doi.org/10.1377/hlthaff.2018.0106AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSVeterans healthQuality of careMarketsMedicareGovernment programs and policiesClinical practiceHospital carePublic healthOrganization of careMy colleagues and I agree with William Weeks that markets matter and there is often variation in quality of care across locations. We controlled for this variation in our study (Jan 2018) using a fixed effect for geographic region (see the article’s online appendix for further explanation of the use and interpretation of this effect).1 Thus, our work identifies the highest-performing system within a particular market. On average, across the country, the Department of Veterans Affairs (VA) provides higher-quality care than Medicare.Weeks suggests the VA should design programs encouraging veterans to use the highest-quality health care within a region. We support the development of such programs.On a broader note, Weeks states that outcomes for veterans would be better if they used high-quality community care, citing his own study in support. However, our work as well as systematic literature reviews provide evidence to the contrary: The VA provides similar- or higher-quality care than the private sector.2 Furthermore, Weeks’s paper notes that due to a lack of risk adjustment, “no conclusions should be drawn regarding the relative performance of VHA and the private sector from this analysis.”3VA-to-Medicare comparisons provide important information about how health care system organization and financing affect quality of care. In the case of end-of-life cancer care, after adjusting for market characteristics, the VA outperforms Medicare.NOTES1 To access the original article’s appendix, click on the Details tab of the article online. Gidwani-Marszowski R, Needleman J, Mor V, Faricy-Anderson K, Boothroyd DB, Hsin Get al. Quality of end-of-life care is higher in the VA compared to care paid for by traditional Medicare. Health Aff (Millwood). 2018;37(1):95–103. Go to the article, Google Scholar 2 Trivedi AN, Matula S, Miake-Lye I, Glassman PA, Shekelle P, Asch S. Systematic review: comparison of the quality of medical care in Veterans Affairs and non–Veterans Affairs settings. Med Care. 2011;49(1):76–88. Crossref, Medline, Google Scholar 3 Weeks WB, West AN, Wallace AE, Lee RE, Goodman DC, Dimick JBet al. Reducing avoidable deaths among veterans: directing private-sector surgical care to high-performance hospitals. Am J Public Health 2007;97(12):2190–1. Crossref, Google Scholar Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 April 2018 Information© 2018 Project HOPE—The People-to-People Health Foundation, Inc.PDF download