Williams S J, Belcher D W, Moscovice I, Inui T S
J Health Polit Policy Law. 1980 Spring;5(1):98-119. doi: 10.1215/03616878-5-1-98.
Criticisms of the Veterans Administration health care system have centered in part on the ability of the system to reallocate resources in response to the changing needs of veterans. VA hospitals use traditional budgeting and planning processes; new programs and projected increases in workload are added to the previous year's budget to yield the budget for the succeeding year. Since these activities occur on an individual institution bases, there is little effort to plan cooperatively between hospitals or to reassess the fundamental allocation of resources based on veteran needs. Over the past two years, the VA has devised a program of regionalized budgeting and planming. The publicity surrounding VA regionalization reflects the idealized potential of shared resources and joint planning within each of the newly created VA medical districts. The reality of the program, however, when examined on a national basis and illustrated by an in-depth study of five hospitals in one district, indicates that there has been little use of resource allocation methodology and that few planning resources have been allocated to this effort. As a result, the district program is a collation of individual hospital budgets, and plans to yield the district budget and plans. Regionalization is unlikely to succeed in any meaningful manner within the VA unless further changes occur in district resource allocation methods.
对退伍军人管理局医疗保健系统的批评部分集中在该系统根据退伍军人不断变化的需求重新分配资源的能力上。退伍军人管理局的医院采用传统的预算编制和规划流程；新的项目和预计增加的工作量被添加到上一年的预算中，以得出下一年的预算。由于这些活动是在各个机构的基础上进行的，因此医院之间几乎没有合作规划的努力，也没有根据退伍军人的需求重新评估资源的基本分配情况。在过去的两年里，退伍军人管理局制定了一项区域化预算编制和规划计划。围绕退伍军人管理局区域化的宣传反映了每个新设立的退伍军人管理局医疗区共享资源和联合规划的理想化潜力。然而，从全国范围来看，并通过对一个地区的五家医院进行深入研究表明，该计划的实际情况是，资源分配方法几乎没有得到应用，而且几乎没有为这项工作分配规划资源。结果，该地区的计划只是各个医院预算的汇总，并据此得出地区预算和计划。除非地区资源分配方法发生进一步变化，否则区域化在退伍军人管理局内不太可能以任何有意义的方式取得成功。
