Best Care Anywhere? The VA?

April 27, 2010

You better believe it.

The second edition of Best Care Anywhere: Why VA Health Care I Better Than Yours just hit the bookstore shelves and I just lapped it up. I was offered the first edition of this book back in 2007 when I was new to working in health care and so very uninformed about it. This book really swept away the cobwebs in my mind in that I had no concept that the incentives imbedded in our system of medical care delivery did not always encourage the best care. It, in fact, encourages more care which as we know from decades of work in comparing medical effectiveness (see Dartmouth Atlas of Health Care) actually suggests a negative correlation to outcomes.

In that way, this book very much undersells itself – it’s about way more than just the VHA. It does what it sets out to do by spelling out what researchers have found which is that in a broad range of metrics, the care provided our veterans in the Veterans Health Administration is the best care available in America  today. It’s also telling that this second edition is made available some 3+ years after the original and the data still hold true.

What is this data, you might ask:

  • New England Medical Journal noted that the VHA was “significantly better” in all measures connected with fee-for-service Medicare
  • Annals of Internal Medicine reported that the VHA was the best in all seven measures of quality in comparison to its private industry counterparts
  • RAND study concludes that the VHA outperforms all other sectors of American health care in 294 measures of quality
  • National Quality Research Center in Michigan found that the VHA had the highest patient satisfaction of any public or private sector health care system
  • Journal of the AMA wrote in 2005 that the VHA “quickly emerged as a bright start of patient safety”

That’s not even the whole list. And, by the way, they do it at a per-member cost that is a little over 8% less than private sector counterparts. More value at lest cost. I thought that was only supposed to be possible in the private sector.

Well, as it turns out, another thing the author succinctly points out is medical care does not behave like other markets. The author refers to this phenomenon as Roemer’s Law. Put succinctly: in typical markets, increased supply leads to lower prices, in medical care more supply just results in more utilization and higher costs. See, all this stuff in a very small package – and extremely quick read – and you have the makings of a classic. And it is.


2 Responses to “Best Care Anywhere? The VA?”

  1. Peter Andrews Says:

    Thanks for bringing my attention to this. You misspelled ‘than’ as ‘tan’ in this post and on your Amazon review. Of course, given the importance of vitamin D perhaps giving people a tan would result in better health all around… 😉


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