Suchergebnisse

The Veterans Health Administration (VHA) has historically served a disproportionately male patient population with lower income and greater rates of mental illness than non-VHA populations. The generalizability of research based on VHA enrollees is unknown because the overlap between VHA and non-VHA populations has never been empirically examined. This study used 2013 National Health Interview Survey data to examine the extent to which VHA enrollees had similar demographic and health characteristics as individuals with Medicaid, Medicare, or private insurance coverage, based on propensity score models. A majority of male VHA enrollees were similar to Medicare beneficiaries suggesting greater generalizability of VHA studies than commonly hypothesized. Overlap declined when comparing with Medicaid enrollees or privately insured individuals, suggesting more limited generalizability of VHA studies to these populations.

Recent news reports suggest that veterans' health care may be inadequate. We use Health and Retirement Study data to compare utilization rates for preventative care by male veterans and nonveterans before and after the near‐universal health coverage at Medicare eligibility. Larger increases in utilization rates for preventative services upon reaching Medicare eligibility at age 65 are associated with less health care adequacy before Medicare eligibility. Results suggest that health care adequacy for male veterans between the ages of 56 and 64 is at least as good as that of nonveterans and may be better. (JEL I14, J14)

Relative to the general population, lesbian and bisexual (LB) women are overrepresented in the military and are significantly more likely to have a history of military service compared to all adult women. Due to institutional policies and stigma associated with a gay or lesbian identity, very little empirical research has been done on this group of women veterans. Available data suggest that compared to heterosexual women veterans, LB women veterans are likely to experience heightened levels of prejudice and discrimination, victimization, including greater incidence of rape, as well as adverse health and substance use disorders. They are also likely to encounter a host of unique issues when accessing health care, including fears of insensitive care and difficulty disclosing sexual orientation to Veterans Health Administration (VHA) providers. Training of staff and providers, education efforts, outreach activities, and research on this subpopulation are critical to ensure equitable and high quality service delivery.

Testimony issued by the Government Accountability Office with an abstract that begins "The Veterans Health Administration (VHA) has been using miscellaneous obligations for over 60 years to record estimates of obligations to be incurred at a later time. The large percentage of procurements recorded as miscellaneous obligations in fiscal year 2007 raised questions about whether proper controls were in place over the authorization and use of billions of dollars. GAO's testimony provides preliminary findings related to (1) how VHA used miscellaneous obligations during fiscal year 2007, and (2) whether the Department of Veterans' Affairs (VA) policies and procedures were designed to provide adequate controls over their authorization and use. GAO recently provided its related draft report to the Secretary of Veterans Affairs for review and comment and plans to issue its final report as a follow-up to this testimony. GAO obtained and analyzed available VHA data on miscellaneous obligations, reviewed VA policies and procedures, and reviewed a nongeneralizable sample of 42 miscellaneous obligations at three case study locations. GAO's related draft report includes four recommendations to strengthen internal controls governing the authorization and use of miscellaneous obligations, in compliance with applicable federal appropriations law and internal control standards."

Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembers and eligible family members, many veterans, and retirees receive health care through the two largest learning health care systems in the USA, managed and delivered through the Departments of Defense (DoD), Veterans Affairs (VA), and contracted health care organizations. Through a network of collaborative relationships, DoD, VA, and partnering health care and research organizations (university, corporate, community, and government) accelerate research translation into best practices and policy across the USA and beyond. This article outlines military and veteran health research translation as summarized from a collaborative workshop led by experts across health care research, practice, and administration in DoD, VA, the National Institutes of Health, and affiliated universities. Key themes and recommendations for research translation are outlined in areas of: (a) stakeholder engagement and collaboration; (b) implementation science methods; and (c) funding along the translation continuum. Overall, the ability to rapidly translate research into clinical practice and policy for positive health outcomes requires collaborative relationships among many stakeholders. This includes servicemembers, veterans, and their families along with researchers, health care clinicians, and administrators, as well as policymakers and the broader population.

The Veterans Health Administration (VA) is among the most unusual and misunderstood institutions in the American welfare state. Unlike most American social services, veterans' medical care continues to be administered directly by the state, contrary to the "antibureaucratic strategy" of "hidden" or "submerged" state-building that has dominated US social policy for decades. Drawing on extensive archival research, I attempt to make sense of the VA's unique policy trajectory by exploring two puzzling episodes of institutional change in the delivery of veterans' health care. Although many bureaucratic models predict large new undertakings initiated by agencies only when they benefit from the advantages of being well-regarded and relatively autonomous, both instances of institutional change occurred at the nadir of the VA's reputation as a competent, innovative, and politically-powerful agency. To explain these unexpected transformations, I investigate the role of bureaucrats in shaping the development of the American welfare state and develop the concept of collaborative state-building to demonstrate how public-private partnerships may contribute to the expansion of social welfare programs in liberal states. Although public-private partnerships are usually seen as an erosion of state power or a way to hide the state's role in the provision of social services, the case of the VA suggests that such partnerships may be used to support and expand such programs. I also focus on the VA's many scandals and show how agency officials used these policy failures to expand the VA.

This brief summarizes a scholarly article of the same name. It highlights research which evaluates how the Veterans Health Administration provides vocational services and training for OEF and OIF veterans with mental health conditions.