Summary: A new study finds that knee replacement done at Veterans Affairs hospitals has better clinical outcomes than surgery farmed out by the VA to private providers in the community. The VA – socialized medicine – works well.
Comparing Complication Rates After Elective Total Knee Arthroplasty Delivered Or Purchased By The VA, Health Affairs, Aug. 1, 2021, by AH Harris et al.
From the abstract: The Department of Veterans Affairs (VA) both delivers health care in its own facilities and, increasingly, purchases care for veterans in the community…We compared risk-adjusted major postoperative complication rates for total knee arthroplasties that were delivered in VA facilities versus purchased from community providers. Overall, adjusted complication rates were significantly lower for arthroplasties delivered by the VA compared with those that were purchased.
From the article: Since the passage of the Choice Act [in 2014] the VA has evolved from a health care delivery system – with 90% of its budget allocated to providing care – into a deliverer and purchaser of care in the community…the VA has devoted 22% of its fiscal year 2021 health care funds to purchasing community care. This percentage may increase even further with the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (also known as the MISSION Act).
Comment and graph:
By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.
Private hospitals and medical groups itching to get their hands on VA funds have used complaints about VA wait times to push Congress to ship VA dollars to private sector care, despite the fact that wait times are generally shorter at the VA’s own facilities.
Previous studies have found that VA care is generally better than care in the civilian sector. (see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215146/, https://www.hsrd.research.va.gov/publications/esp/quality.pdf, and https://www.rand.org/pubs/external_publications/EP67588.html). As shown in the chart below, this new study indicates that the outsourcing of knee replacement substantially increases patients’ complications.
The right way to address VA waits is to assure adequate funding, not to divert funds from superior VA facilities to inferior nearby community hospitals.
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