Posts Tagged quality health care

Privatize the VA? Pay more for less.

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Should the US privatize the Veterans Administration hospitals and clinics?  Let’s put the assumptions in the question on the table:

  • Bureaucracy is bad
  • US health care is good
  • The US is in continuous war
  • Treating the wounded is too expensive

This blog is about healthcare, not geopolitics, yet the temptation to see war as a disease is difficult ignore.  Let’s not go there.  Instead, compare the VA system with the proposed replacement.

VA Healthcare Private US Healthcare
  • Lower drug prices due to negotiation by the system
  • Expertise with PTSD, alcoholism, tobaccoism, drug addiction, low income, amputations and poor literacy.
  • Group sessions with people having a military background
  • Funding is always in doubt
  • Managed as a system, although management is only fair.
  • World healthcare rank is unknown, but is likely better than the US as a whole.
  • High drug prices due to lack of negotiation at the system level
  • Primary care is unequipped to deal with social and psychiatric problems (not in the usual five-minute visit that is profitable)
  • Group treatments with people who might dislike the military.
  • No limits on costs and profits
  • Highly influenced by the biggest lobbying efforts in the US
  • Not managed as a system
  • World healthcare rank is 26th.

Would a veteran actually want private healthcare?  Perhaps veterans living a long distance from a VA facility would choose private care.  But, if VA facilities are close who would want to enter a private system that is hugely expensive, not focused on war injuries, poorly managed, and has low quality ratings?

The real answer to the initial question is that private US healthcare needs to improve tremendously.  If and when that happens then the need for the VA would naturally disappear.  And, by the way, less war would help.

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Patient Satisfaction (the CMS view)

The chart above is extracted from CMS data.  All US hospitals are now required to collect data on patient satisfaction.  This data is used by Medicare to adjust hospital payments upward for good satisfaction scores or downward for poor satisfaction scores.  This new payment adjustment certainly has the attention of hospitals since the adjustment amounts to a significant amount of money.

If one looks at the actual questions they really are pointed toward the quality of communication.   The questions are not about whether the treatment was satisfactory but whether there was good communication between the patient and the doctors, nurses and other staff.  The focus on communication tends to get around the criticism that sick people are never satisfied because they have some disease.   Even a sick patient can be quite satisfied (or not) with the communication received during a hospitalization.

The above table is the summary for the entire US.  The data is subject to a selection bias because the patient selects the hospital with some intent to select a good one.  But given that bias the results are not all that great — about 20% of patients did not feel they always had good communication with nurses and doctors.

Satisfaction is not the same thing as quality health care.  You might have been given the wrong medication or had unnecessary surgery but you went away happy (and ignorant of the problems).  Doing the right thing and getting a good outcome is what hospitals need to focus on.  Patient satisfaction is a small step in the right direction.

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