In cancer care, VA compares favorably with private sector
A team with VA, Harvard Medical School, Mount Sinai Medical Center, and the Dana-Farber Cancer Institute compared the quality of cancer care for older men who were diagnosed in VA or at a Medicare fee-for-service facility between 2001 and 2004 and followed through 2005. The two health systems came up about equal on nine measures of care.
On the plus side for VA, VA patients with colorectal cancer were diagnosed at earlier stages and had higher rates of curative surgery. They also had higher rates of chemotherapy for certain type of lymphoma, and were more likely to receive drugs known as bisphosphonates for myeloma.
The only measure on which Medicare exceeded VA was the use of an advanced type of radiation, known as 3D-CRT/IMRT, to treat prostate cancer.
The authors conclude that "care for older men with cancer diagnosed or treated in VHA [the Veterans Health Administration] was generally comparable to or better than care for older men enrolled in fee-for-service Medicare, although there may be delayed adoption of some expensive new technologies. More research is needed to understand the reasons for underuse of effective therapies in older men and to determine the right rates of treatment. Nevertheless, our results provide encouraging support for the effectiveness of health care delivery, including specialized cancer care, for men in the VHA and suggest that the VHA system might serve as a model for care delivery as health care reform is implemented, particularly with the need to deliver care of high quality and high value."
The article was accompanied by an editorial by cancer-care experts Joan Ryoo, MD, and Jennifer Malin, MD, PhD, both associated with the University of California, Los Angeles. They wrote: "Since it was systemically (and systematically) 're-engineered' along a more decentralized, managed care template over fifteen years ago, the Veterans Health Administration has demonstrated accumulating achievements in health and health care delivery, outshining not only its own performance over time, but that of others." (Annals of Internal Medicine, June 7, 2011)
This article originally appeared in the July-August 2011 issue of VA Research Currents.