The VHA is the integrated health system providing healthcare to US military veterans managed by the Department of Veteran Affairs. It is currently regarded by by some other health systems as a model to learn from (see here for a recent report about how the UK's NHS could learn how to implement integrated electronic health records effectively, something it has spent a lot of money on without producing useful results).

Philip Longman's book Best Care Anywhere argues that the VHA offers its members some of the highest quality care available anywhere in the US while doing so within a very frugal budget. To quote from the Amazon summary (my emphasis):

This important book describes the turnaround of the VA health-care system—now widely recognized as leading the nation in terms of both quality and costs—and offers insights that will be useful to patients and policymakers alike.

Better quality and cheaper care: is this true?


In a recent (2018) article on infighting among Trump officials running the VHA, The Economist reports an explanation of why many Americans find it so hard to believe the VHA does a good job (counter to the widespread belief in the USA that "socialised" medicine is always bad). My emphasis:

For many Americans, the phrase “veterans’ health care” conjures images of scandal and ineptitude. Much of this is because of a crisis in 2014, when it was discovered that hospital officials had falsified records to avoid reporting delays in appointments. Heads rolled when it appeared that 40 ex-servicemen had died while waiting for appointments. Less coverage was given to later investigations, which have been largely unable to blame the deaths on the extended waiting times.

But the reality is different:

Most Americans would be shocked to learn that the VA health system actually seems to provide higher-quality care than its competitors. A review by the RAND Corporation showed that the VA outperformed non-VA care on 45 of 47 outpatient quality measures. More than 80% of new primary care patients are able to get an appointment within two weeks. Annual surveys show satisfaction levels with treatment close to 80%. In-patient care was more mixed, however, and performance tends to vary greatly between hospitals. Clearly the system needs fixing, but fundamentally broken it does not appear to be.

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    @RobZ No single metric captures all the elements of quality, but I'd expect that looking at Outcomes, patient satisfaction, medical error rates and other related issues might give some good pointers.
    – matt_black
    Mar 15, 2013 at 21:20
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    It's highly contentious to say VHA is 'subsidized' by the rest of the system. VHA gets a good deal on drugs and services, but that's just because its a big purchaser. Pure free market economics. Nothing to do with subsidy. Mar 16, 2013 at 3:21
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    @DVK It is true that some US drug companies, for example, argue that the VHA (and most European health systems for that matter) are subsidised by the high prices in the US free market. But it could equally be argued that the "free market" US system has protected industry against competitive pressures allowing them to price gouge their customers to an extraordinary degree. Given that most spend more on marketing than R&D I don't think the argument they would stop developing or selling products if prices were lower is a strong one.
    – matt_black
    Mar 16, 2013 at 12:29
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    @DVK If I could price gouge customers as much as US drug companies do and without the sorts of consumer protection provided in Europe, I'd move to the US. OTOH Europe has quite a few big drug companies, so it can't be that bad. Besides, the issue is not which market is attractive, but whether lower prices would force some firms out of business which is stretching credibility given the current profit margins. Drug firms are still very profitable at European prices so arguing that those prices lower innovation because firms can't make money is ridiculous.
    – matt_black
    Mar 16, 2013 at 13:17
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    @dvk In response to your comment about the relative healthiness of VHA patients. Two facts: one, they are a much less healthy demographic than the average US population; two, if they are health-conscious that could be because of how the VHA encourages their patients to behave (so a consequence of VHA actions not and external explanation of why their results look good). I'd like to see some analysis of these factors in an answer.
    – matt_black
    Mar 16, 2013 at 13:22

1 Answer 1


Here is wiki's summary of recent investigations. RAND's is the only one with positive findings.

Here is the RAND's press release. It does have some positive info, but also states that:

However, waiting times are highly variable by location and type of care and some veterans in some facilities face very long wait times, such as almost 40 days for a primary care appointment at the extreme. In addition, surveys show that VA patients are less likely than private-sector patients to get appointments, care and information as soon as needed.

Reports are linked here. I do not have time to read them, but it is important to check if their comparison is to treatment & outcomes from non-VA hospitals for veterans alone, or for general public. I suspect that compared to a typical US patient, veterans are more likely to comply with doctor's orders, are more fit, and less likely to "complain" in surveys.

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    There are several problems with your answer. One is that your summary of the RAND results is heavily biased, quoting the negative and reducing the positive to "does have some positive info". And you dismiss some reports because you don't have time to read them but then speculate that their comparisons might be invalid on speculative grounds you suggest without any actual supporting evidence. This isn't a fair summary of even the evidence you link to.
    – matt_black
    Mar 5, 2018 at 14:58

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