Tóm tắt

One of the core responsibilities of the U.S. Department of Veterans Affairs (VA) involves providing health care services to eligible Veterans. Although VA has traditionally carried out its health care role primarily by operating a national network of hospitals and other facilities, the agency also administers a purchased care function through which it pays for health care services from outside providers. VA’s purchased care function has evolved primarily to address situations in which VA’s direct-care resources are unable to offer needed services to Veterans. Moreover, the function is bounded by the fiscal context of a discretionary VA health benefit funded by a limited annual budget appropriation.1 Although purchased care has accounted for only a small fraction of VA’s health care budget over the past decade, that fraction is growing. In the wake of the recent crisis in access to care through VA facilities, stakeholders and policymakers are revisiting the role and performance of VA purchased care. Specifically, they are considering whether modifications to VA’s purchased care approach might be desirable, given broader goals of expanding access to care, enhancing trusted partnerships, and improving VA operations to deliver seamless and integrated support for the health of Veterans. The Veterans Choice Act and the assessment mandate for this report were passed into law in the summer of 2014. Broadly, the act represented a congressional response to an acute access crisis in Phoenix, Arizona, and other parts of the country. In some important respects, the Veterans Choice Act spotlighted purchased care both as a device for ensuring Veterans’ access to services and as a focal point for policy-makers’ attention moving forward. The assessment mandate for this report was established specifically by Section 201(a)(1)(C) of the Veterans Choice Act. That mandate called for a study to address “the authorities and mechanisms under which the Secretary may furnish hospital care, medical services, and other health care at non-Department facilities, including whether the Secretary should have the authority to furnish such care and services at such facilities through the completion of episodes of care.