DOES THE COUNTRY need more Veterans Administration hospitals? Is the care adequate? Is it sound policy for VA hospitals to be affiliated with medical schools? What policy decisions are being [WORD ILLEGIBLE] to prepare for the increased percentage of older veterans in coming years?
These are among a few of the questions discussed in detail in the study of veterans' health care released this week by the National Research Council of the National Academy of Sciences. If the study, which took three years to complete and cost $6 million, does nothing else, it adds an authoritative voice to the growing argument that the VA needs to rethink its policy of adding more and more hospital beds to its system. "The VA," the study notes, "is currently investing substantial funds in a . . . program that [WORD ILLEGIBLE] construction of new hospital beds to replace older beds. Since 1975, 91.1 billion has been appropriated, and $479 million has been requested for fiscal year 1978 - a total of $1.6 billion in four years mainly for general-hospital beds. This is being done despite the surplus of VA hospital beds, the existence of more than adequate short-term bed capacity in community hospitals in most areas of the country and the possiblity of a drop in demand for VA hospital beds if national health insurance is enacted."
In addition, the study finds that many veterans in the hospitals do not require hospitalization at all. Moreover, in 1975, almost half of the veterans dicharged from VA surgical beds underwent no surgery. Of the psychiatric patients, the report finds that much of the care "appears to be custodial, rather than therapeutic." Those who do receive adequate care often owe it to the luck of the draw; one hospital may provide more than six hours of therapy a week, while another provides less than half an hour. As for alcoholic patients, the study finds that only "small numbers" are being served.
In the past, veterans went to VA hospitals because they knew they would receive the kind of help they could find nowhere else. Individuals with service-oriented disabilities were in the mind of Congress when it established VA hospitals after World War I. If room existed, the hospitals could accept veterans without service-connected disabilities. According to the study, the changes of 50 years - from the emergence of health-insurance plans to federal involvement in public health care - have created new demands on the hospitals that are currently nor being met by the old procedures. Today, for example, about 70 per cent of the three million veterans in the hospitals do not have service-connected disabilities.
The mandate has changed, and now the question is whether the structure can change also. None of this is to discredit the work, and often heroism, of the staffs in many of the 171 VA hospitals. As the study reports, "patients are generally satisfied with medical and surgical care received in VA hospitals." But the issue is larger than that. It has to do with how the system of VA hospitals - amounting to $4 billion a year, which is 10 per cent of the annual federal budget for health care - fits into the overall national health-care picture. The issue has less to do with the value of the VA hospitals, which is not being questioned, than their role.