The Department of Veterans Affairs health-care system — or the Veterans Health Administration — is the focus of the appointment scheduling scandal that has generated calls for VA Secretary Eric K. Shinseki’s resignation. But the system, central to the massive agency, has been plagued with service delays and scheduling manipulation for years.
Enrollees: About 9.3 million of the nation’s 22 million veterans are enrolled in the VA health-care system. Veterans qualify for health-care benefits if they have served in the active military and have not been dishonorably discharged.
Facilities: The VHA is home to the largest integrated health-care network in the nation, with 150 VA hospitals and 820 outpatient clinics, as of 2013. The agency operates at least one medical center in each state, as well as in the District of Columbia and Puerto Rico.
Utilization: The health system handled about 84 million outpatient visits in 2012, representing a 23 percent increase compared with 2008. Shinseki said in testimony in March that a projected 6.7 million patients probably would use the network in 2015, representing a 17 percent increase compared with 2009.
In the VA’s 2010 national survey of veterans, 16 percent of respondents said they use the system as their primary source of health care, while 35 percent said they use it as a safety net and 32 percent indicated they don’t plan to use it.
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Patient satisfaction: Despite its troubles, the VA health system earned marks equal to or better than networks in the private sector in the 2013 American Customer Satisfaction Index.
The health system earned overall satisfaction indexes of 84 for inpatient care and 82 for outpatient services, while the U.S. hospital industry earned scores of 80 and 83, respectively.
Jacob Gadd, the American Legion’s deputy director for health care, said the scores probably reflect “pride among veterans that there’s a system for them that understands their unique needs.”
A history of scheduling problems: Since 2005, the VA inspector general’s office has issued 18 reports identifying appointment scheduling problems, some resulting in long wait times and having a negative effect on patient care.
In 2010, a top VA official issued a memo to the department’s medical centers listing 17 schemes that VA clinics were known to be using to cover up treatment delays. The memo said the practices would not be tolerated.
Spending: In general, slightly more than 40 percent of the VA’s annual budgets went toward medical care between 2000 and 2013, although the percentage dipped last year to 38 percent of the VA’s $139 billion budget for benefits and services.
The VA spent $52.5 billion on hospital and medical care in 2013, more than double its expenditures in that category for 2000.
Staffing: VHA employees accounted for nearly 89 percent of the VA’s 278,565 workers in 2008.
An audit two years ago determined that the agency had not developed an effective method for determining whether staffing levels were appropriate at any given clinic. VA health official Thomas Lynch said at a hearing Wednesday that the department is not sure whether it needs to add or shift personnel to address the scheduling problems.
Origins: The first national effort to provide medical care to veterans started in 1812, with the Naval Home in Philadelphia, according to a VA history. The U.S. government created homes for disabled veterans after the Civil War, with the facilities offering limited medical care at first and eventually providing hospital-level care.
Sources: VA fact sheets and White House historical tables.