United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1998-04-30 monographic deposited born digital 328 p. GA 1.13:HEHS-98-32 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-32 P0b002ee180393910 f:he98032 DGPO 2010-08-12 2011-03-24 GAOREPORTS-HEHS-98-32 machine generated eng fdlp REPORT GAOREPORTS-HEHS-98-32 HEHS-98-32 Comparative analysis Veterans hospitals Community hospitals Health care programs Hospital care services Cost effectiveness analysis Physicians Medical education Health resources utilization Hospital bed count Civilian Health and Medical Program of the Department of Veterans Affairs Civilian Health and Medical Program of the Uniformed Services CHAMPUS Medicare Program Medicaid Program DOD TRICARE Program VA Veterans Integrated Service Network Federal Employees Health Benefits Program VA Northern California Health Care System VA Veterans Equitable Resource Allocation System Chapter Report HEHS

Pursuant to a congressional request, GAO reviewed major issues and challenges that Congress and the administration will face in the next few years concerning Department of Veterans Affairs (VA) hospitals, focusing on: (1) how VA and community hospitals' care evolved during the twentieth century, including changes in supply and demand; (2) factors contributing to the declining demand; (3) the extent of excess capacity; (4) actions taken to increase efficiency and compete for patients; and (5) changes in hospitals involved in training the nation's physicians and conducting medical research.<p/>GAO noted that: (1) both community and VA hospitals are struggling to survive; (2) demand for hospital care abruptly reversed and has steadily declined since the 1980s in community hospitals and since the 1960s in VA hospitals; (3) although many factors contributed to the reversal, medical advances and changes in health insurance mainly drove changes to community hospitals; (4) VA hospitals, however, were mainly affected by declining numbers of veterans and the improving health care options available to veterans through Medicare and other insurance; (5) GAO's work, and studies by others, suggest that if trends continue, 60 percent or more of community hospital beds and over 80 percent of VA hospital beds may not be needed in the next 15 years; (6) if such reductions occur, many hospitals will cease operation; (7) VA's current strategy for attracting new users may not generate the demand needed to preserve VA hospitals; (8) new users have indicated they are more likely to choose their local hospitals rather than a distant VA facility; (9) if VA decides to directly compete with community hospitals for market share, then it will have to subsequently decide whether to adopt private-sector marketing techniques; (10) both VA and community hospitals are fundamentally changing the ways they operate; (11) such changes include the hospitals' basic structure and management; reinvention of basic work, procurement, and supply processes; development of new marketing strategies; and methods and procedures of monitoring and delivering patient care; (12) teaching hospitals' use of medical residents as a lower cost labor source is often seen as contributing to the oversupply of physicians; (13) Congress, through the Balanced Budget Act of 1997, gave non-VA teaching hospitals financial incentives through the Medicare program to reduce residency positions; (14) both VA's strategic goals and the incentives it is creating through some of its restructuring efforts suggest that VA, like many community hospitals, is focusing its marketing efforts on attracting revenue-generating patients; (15) decisions on the future of VA hospitals, whether they mean closing hospitals or opening them to nonveterans, have significant implications for veterans, VA employees, affiliated medical schools, community hospitals, and taxpayers; and (16) therefore, Congress and the administration must have sufficient information for properly assessing the potential effects of VA's health care system changes on all stakeholders. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-32/html/GAOREPORTS-HEHS-98-32.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-32/pdf/GAOREPORTS-HEHS-98-32.pdf GAO/HEHS-98-32 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-32 Chapter Report GAO/HEHS-98-32; VA Hospitals: Issues and Challenges for the Future; Comparative analysis Veterans hospitals Community hospitals Health care programs Hospital care services Cost effectiveness analysis Physicians Medical education Health resources utilization Hospital bed count Civilian Health and Medical Program of the Department of Veterans Affairs Civilian Health and Medical Program of the Uniformed Services CHAMPUS Medicare Program Medicaid Program DOD TRICARE Program VA Veterans Integrated Service Network Federal Employees Health Benefits Program VA Northern California Health Care System VA Veterans Equitable Resource Allocation System Title 38 Section 1710 38 U.S.C. 1710 Title 42 Section 426-1 42 U.S.C. 426-1 Public Law 79-725 Public Law 93-82 Public Law 100-322 Public Law 101-366 Public Law 102-405 Public Law 103-355 Public Law 103-446 Public Law 103-452 Public Law 104-106 Public Law 104-191 Public Law 104-204 Public Law 104-262 Public Law 105-18