Well, I did say the VHA has its problems, and I do think that it is extraordinarily difficult (and often misleading) to compare across systems (both within countries and across countries). But just judging on the basis of what has been 'measured' (i.e. simple, select process quality measures, mainly in the non-acute sector, which has probably been underfunded), the VHA seems to have done quite well, both compared to other systems in the US (though Medicare has been catching up recently), and compared to itself over time.
It's also important, I think, to note that though the VHA reform experiences and those of the UK NHS did bear some close similarities up until circa 2000 (and although the basic organizational structure of the two systems is still very similar - incidentally, I'm not too convinced that 'consumer' expectations are grreater in the VHA), the path that the NHS has more recently taken, with its emphasis on demand-side competition (i.e. greater patient choice) is very different, or so it seems to me.
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Subject: VHA performance and measurement
The VHA has done much in terms of performance, primary care provision and continuity of provider to patient. In these area a fine model-- not without controversy --for how well a single payer system can perform. Ironically the VHA derived its recent reforms from the NHS market inspired reform model began under Thatcher.
Much of the recent focus by the lay press and peer reviewed press alike on the VHA and other systems are around select performance measures in: preventive care, outpatient interventions and application of select evidence-based practices. That leaves much un-examined in the realm of quality and safe patient care: sentinel events; nosocomial infections (often not diagnosed until post discharge given short lengths-of-stay), communication; etc.
The US new Pay for Performance system soon to be implemented around Medicare will also drive health systems to focus on select measures.
The important message here for all--researchers, practitioners healthcare mangers and policy-makers is to not to over-state the effectiveness of select measures as definitive of quality care or allow the pressure to perform well by them drive the system therein ignoring other areas essential to quality.
Marilyn
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Dr. Marilyn A. DeLuca
Executive Director
Jonas Center for Nursing Excellence
107 East 70th Street
New York, NY 10021
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T: 212.609.1585
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