Office of Productivity, Efficiency, and Staffing, Department of Veterans Affairs, Albany, New York, USA.
Health Aff (Millwood). 2011 Apr;30(4):655-63. doi: 10.1377/hlthaff.2010.0435.
There is widespread belief that the US health care system could realize significant improvements in efficiency, savings, and patient outcomes if care were provided in a more integrated and accountable way. We examined efficiency and its relationship to quality of care for medical centers run by the Veterans Health Administration of the Department of Veterans Affairs (VA), a national, vertically integrated health care system that is accountable for a large patient population. After devising a statistical model to indicate efficiency, we found that VA medical centers were highly efficient. We also found only modest variation in the level of efficiency and cost across VA medical centers, and a positive correlation overall between greater efficiency and higher inpatient quality. These findings for VA medical centers suggest that efforts to drive integration and accountability in other parts of the US health care system might have important payoffs in reducing variations in cost without sacrificing quality. Policy makers should focus on what aspects of certain VA medical centers allow them to provide better care at lower costs and consider policies that incentivize other providers, both within and outside the VA, to adopt these practices.
人们普遍认为，如果医疗服务以更加整合和负责的方式提供，美国的医疗保健系统可以在效率、节约和患者结果方面实现重大改进。我们研究了退伍军人事务部（VA）退伍军人健康管理局（VA）运营的医疗中心的效率及其与护理质量的关系，该医疗中心是一个全国性的垂直整合的医疗保健系统，负责为数众多的患者。在设计了一个表示效率的统计模型之后，我们发现 VA 医疗中心的效率很高。我们还发现，VA 医疗中心之间的效率和成本水平差异不大，并且总体上效率越高，住院患者的质量越高。这些 VA 医疗中心的发现表明，在美国医疗保健系统的其他部分推动整合和负责的努力可能会在不牺牲质量的情况下，在降低成本差异方面带来重要的回报。政策制定者应该关注某些 VA 医疗中心的哪些方面使它们能够以更低的成本提供更好的护理，并考虑鼓励 VA 内外的其他提供者采用这些做法的政策。
