As Congress moves ahead with plans to outsource more and more veteran health care to the private sector, three high-profile studies should urge lawmakers to pump the brakes. The studies, published in recent weeks by RAND Corporation, Federal Practitioner, and the National Academies of Science, Engineering and Medicine, spotlight serious flaws in private-sector veterans’ care compared with the VHA, from suicide prevention to overall health care. In so doing, the reports underscore a critical fact: Despite their best intentions, few private-sector physicians, hospitals, mental health, and other health-care professionals have the knowledge, experience, and skill to provide the level of care veterans need and deserve.
Perhaps the most damning of those studies comes from the RAND Corporation. In a report entitled “Ready or Not?” researchers examined whether private-sector health professionals in New York state had the “capacity” and “readiness” to deal with that state’s 800,000 veterans in need of care. Such patients, the study noted, are on average older, sicker, poorer, and far more complex than the ordinary civilian-sector patient.
The conclusion? Only 2 percent of New York state providers met RAND’s “final definition as ready to provide timely and quality care to veterans in the community.”
While the majority of providers said they had room for new patients, less than 20 percent of them ever asked their patients if they were veterans. Fewer than half used appropriate clinical practice guidelines to treat their patients, and 75 percent didn't use the kind of screening tools commonly deployed in the VHA to detect critical problems like PTSD, depression, and risk of suicide.
Most providers had no understanding of military culture and less than one-half said they were interested in filling such knowledge gaps. Mirroring a similar study conducted by the VA and Medical University of South Carolina in 2011, RAND found that New York state providers had little understanding of the high quality of VHA care. Informed by media reports rather than medical journals, they had a negative view of the VHA and would be unlikely to refer eligible veterans to the VHA for needed care in programs in which the VHA actually excels.
Echoing the RAND study, another report by VA psychologist Russell Lemle in the Federal Practitioner warns that in the private sector, the quality of integrated mental health care for veterans lags significantly behind the VHA. Every VHA medical center, Lemle reports, has at least one trained suicide prevention coordinator who directs care for veterans at high risk for suicide. The VHA has also developed an algorithm to identify the veterans who are at the very highest risk of suicide and notifies their provider of the risk assessment, enabling preemptive intervention and expansion of services to the veteran. This and other programs explains why the rate of suicide of veterans not using the VHA increased by 38 percent between 2001 and 2014 while only 5 percent for those using the VHA. For veterans who had a “mental health or substance use diagnosis, the rate decreased by 25 percent.”
Finally, for veterans returning from the Iraq and Afghanistan conflicts, a prestigious National Academies of Science, Engineering and Medicine report released just four weeks ago found VHA mental health care to be “comparable or superior to that in the private sector.” The majority of veterans who accessed the system had “positive experiences” and appreciated VHA staff’s “respect toward patients.” This was despite serious shortages of mental health staff, as well as clinical and exam space, and confusion about how to access care—all of which could, and should, be improved. When veterans were asked whether needed services were provided in the VHA, 64 percent said they were. When they were asked about services they’d received in the private sector, only 20 percent said they got needed services.
These studies should be a wake-up call to Congress. Countless reports have documented that there is little excess capacity—and a huge shortfall of knowledge—in the private sector when it comes to veteran health care. Until studies document the opposite—that the private sector's doctors, nurses, hospitals and other health-care providers can match what the VHA does routinely—lawmakers should hold off on privatization efforts. Rather than spending money for more expensive private-sector care of lower quality, Congress should instead be working to strengthen the excellent care the VHA gives by providing funding to remedy any staff and resource deficiencies as well as to address management problems at the top.
