Summary

The Department of Veterans Affairs (VA) provides health care to about 2.6 million veterans each year, but veterans in different parts of the country traditionally have not had equal access to these services. A shift of the veteran population from the northeast and the midwest to the south and the west without appropriate reallocation of resources has created inequities in access to services. In April 1997, VA launched the veterans equitable resources allocation system as part of a strategy to improve the equity of veterans' access to health care. The system is designed to allocate resources to 22 regional VA health care networks, which are responsible for distributing resources to hospitals and clinics. This report assesses VA's (1) implementation of the veterans equitable resources allocation system, (2) monitoring of changes in health care delivery resulting from the system, and (3) oversight of the network allocation process used to give veterans equitable access to service.

GAO found that: (1) VERA shows promise for correcting long-standing regional funding imbalances that have impeded veterans' equitable access to services; (2) specifically, VERA allocates more comparable amounts of resources to the 22 networks for high-priority VA health service users--those with service-connected disabilities, low incomes, or special health care needs--than the resource allocation process it has replaced; (3) as a result, if fully implemented as planned, VERA could substantially shift funding among regions by fiscal year (FY) 1999; (4) in addition, VA continues to explore ways to improve VERA's capacity to more equitably allocate resources in the future; (5) among the improvements being considered are better measures of network workloads and adjustments for justifiable differences in network costs for providing health services; (6) although it is early in VERA's implementation, VA headquarters has not established an adequate monitoring system to identify changes in workload and medical practices that could negatively affect allocation equity and the appropriateness of care that veterans receive; (7) in addition, VA headquarters lacks the information to adequately review networks' planned facility services; (8) Veterans Integrated Service Networks (VISN) that GAO contacted are using varying methods to allocate resources to facilities; (9) for example, some VISNs allocate resources on the basis of the number of veterans using a facility; others negotiate changes in funding for programs or services from the preceding fiscal year to reach a new allocation; (10) VISNs, however, lack criteria on how to develop methods to give veterans equitable access; (11) to address these deficiencies, GAO has identified corrective actions for VA to take to enhance its ability to ensure that resources are allocated to improve veterans' equitable access to health care services and ensure that the care received is appropriate; and (12) these actions include improving the timeliness and thoroughness of overseeing changes in health care delivery resulting from the allocation process to the networks and to the facilities.