Summary

The Department of Veterans Affairs (VA) runs one of the nation's largest health care delivery systems, including more than 170 hospitals and more than 200 free-standing clinics. Veterans must often travel long distances, however, to receive care at these facilities. VA has a policy encouraging its hospitals to improve access to care for eligible veterans. As a result, many hospitals have either planned or established new, fee-standing outpatient clinics, known as "access points." Access points provide primary care to veterans and generally refer those needing specialized services or inpatient stays to VA hospitals. This report examines VA's policy for establishing access points. GAO discusses the legal, financial, and mission-related implications of VA's efforts to establish access points.

GAO found that: (1) the new access points represent a proactive effort to transition from a direct delivery system to an integrated network of VA-operated hospitals and VA and non-VA outpatient providers; (2) VA ignored statutory limitations in its legal authority to provide primary care to veterans, but legislation has been enacted which expands VA authority to contract for the provision of such care and veterans' eligibility to receive such services; (3) VA hospitals must finance access points within their existing budgets, which will generally require reallocating resources among current activities and services; (4) although access points should in time allow VA hospitals to serve current users more efficiently, the efficiencies may not generate enough savings to offset the increased costs associated with caring for increased numbers of veterans who may use the new clinics; and (5) because VA has not developed a strategic plan for expanding veterans' access to its medical care system, it is difficult to accurately gauge the number of access points VA will need or the effect they will have on the VA mission.