From the CBO:
Evidence of the Quality of VA’s Health Care
VA officials have often cited studies that have given the department high ratings for the quality of its medical care. For example, then-Secretary of Veterans Affairs James Nicholson stated in a speech in July 2007, "We lead private and Government health care providers in almost every measure and our state-of-the-art quality care arcs from the research lab to a patient’s bedside."7 Michael Kussman, then-Acting (now confirmed) Under Secretary for Health, gave testimony before the Congress in March 2007 in which he called VA "the Nation’s leader in providing high-quality health care" and cited a number of external research studies to support that claim.8
... A 2004 study assessed the quality of care for VA patients and for patients in a national sample.22 Employing a cross-sectional design, the study compared indicators for a sample of VA patients drawn from 26 facilities located in 2 VISNs and for a national sample of patients from 12 communities—using data collected between 1997 and 2000, a period during which performance measurement and electronic medical records had been implemented throughout VA’s medical system. The authors chose to examine process measures, noting that such measures "are more readily actionable than outcomes measures, require less risk adjustment, and follow the structure of national guidelines."23 Altogether, the study included 348 indicators drawn from national guidelines and the medical literature to address both inpatient and outpatient care, including screening, diagnosis, treatment, and follow-up activities.
The study found that, on average, 67 percent of VA patients received the care specified by the indicators, compared with 51 percent of the patients in the national sample. For both chronic care and preventive care, the ratings for VA patients were higher than for the others, but for acute care, slightly lower (although the difference was not statistically significant). For depression, diabetes, hyperlipidemia, and hypertension, VA patients received significantly better care.
...
Possible Explanations for VA’s Achievements in Quality of Care
Observers have suggested a number of factors to explain VA’s higher scores on many measures of health care quality compared with those of other systems. In particular, VA’s structure as an integrated delivery system makes it easier for the department to apply two important tools:
■ Incentives given to managers and providers to meet targets for quality of care and adherence to clinical guidelines and
■ Health IT systems, which include reminders about tests and treatments recommended according to clinical guidelines.
Other factors may also be important in explaining VA’s performance—for example, the low out-of-pocket costs for the department’s health care reduce the disincentives for patients to seek medical care, thus potentially enhancing the department’s performance in meeting clinical guidelines for preventive care and the management of chronic diseases.
http://www.cbo.gov/ftpdocs/88xx/doc8892/MainText.3.1.shtm
