Restoring Trust In VA Health Care

It has been nearly 20 years since the Veterans Health Administration (VHA), the subcabinet agency that oversees the Department of Veterans Affairs (VA) health care system, implemented a series of sweeping reforms that markedly improved quality, boosted access, and increased efficiency.^1,2 Recent revelations about long wait times for veterans compounded by systematic cover-up by VHA administrators make it clear that reforms are again needed. Apparent manipulation and falsification of wait-time data at more than 40 facilities indicate a serious systemic problem.

To some observers, the VA's problems confirm that government cannot manage health care. To others, they tell a simple story of insufficient funding: the VA needs more money to care for the large number of veterans returning from the wars in Iraq and Afghanistan and for aging Vietnam veterans. Unfortunately, neither narrative adequately captures the challenges facing this organization or provides guidance on how we might address them.

Inadequate numbers of primary care providers, aged facilities, overly complicated scheduling processes, and other difficult challenges have thwarted the VA's efforts to meet soaring demand for services. For years, it has been no secret that the VA's front lines of care delivery are understaffed for the needs. And though there can be no excuse for falsifying data, we believe that VA leadership created a toxic milieu when they imposed an unrealistic performance standard and placed high priority on meeting it in the face of these difficult challenges...