Does the government actually run the BEST healthcare?

August 10, 11:24 AMSF Health News ExaminerJefferson Adams

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A new study of the VA health system shows that, contrary to what many
opponents of healthcare believe, the government tun healthcare system
actually leads all competitors in nealry every meaningful measurement
of quality of care. AP Photo/Nati Harnik

 

With the battle to reform healthcare heating up in congress, those opposed to reform are turning up the volume on their timeless chant against "government run" healthcare.

Common refrains include such mantras as "Keep the government out of our healthcare," or "We don't want any socialized medicine;" often chanted by recipients of government-run, socialized medicine in the form of Medicare. Funny that no Republican wants to kill Medicare, nor does anyone, it seems, who relies upon Medicare for their healthcare needs.

The main thrust of the anti-reform argument is that government is bad at running things, and would be terrible at running a healthcare program. Better to entrust running healthcare to the very same private insurers who have gotten rich creating the very problem we have now: skyrocketing premium costs, coverage reductions or limitations, denials due to pre-existing conditions, etc.

But is there really a good argument to be made against government run healthcare plans in general? Certainly, the healthcare enjoyed by members of congress is government-run, as is that offered to our armed servicemen and women. How do they measure up to privately run medical programs?
 
A team of researchers recently set out to compare the quality of VHA care with that of care in a national sample by using a comprehensive quality-of-care measure.

The research team was made up of Steven M. Asch, MD, MPH; Elizabeth A. McGlynn, PhD; Mary M. Hogan, PhD; Rodney A. Hayward, MD; Paul Shekelle, MD, MPH; Lisa Rubenstein, MD; Joan Keesey, BA; John Adams, PhD; and Eve A. Kerr, MD, MPH.

The Veterans Health Administration (VHA) has introduced an integrated electronic medical record, performance measurement, and other system changes directed at improving care. Recent comparisons with other delivery systems have been limited to a small set of indicators.

The researchers made a cross-sectional comparison of 12 VHA health care systems and 12 communities. They looked at 596 VHA patients and 992 patients identified through random-digit dialing. All patients were male and over 35 years of age.

Using a chart-based quality instrument consisting of 348 indicators targeting 26 conditions, the team measured looked at the period between 1997 and 2000. They adjusted results for clustering, age, number of visits, and medical conditions.

VA scores highest in quality of care
The research team found that patients from the VHA scored 16 percentage points higher for adjusted overall quality (67% vs. 51%; difference [95% CI, 14 to 18 percentage points]),

For chronic disease care, the VA finished 13 percentage points higher (72% vs. 59%; difference [CI, 10 to 17 percentage points]).

For preventive care, the VA finished 20 points higher (64% vs. 44%; difference [CI, 12 to 28 percentage points]). The comparison the VA did not win was for acute care.

The VHA held the strongest advantage in processes targeted by VHA performance measurement, where the VA finished 23 percentage points ahead of the competition (66% vs. 43%; difference [CI, 21 to 26 percentage points]).

The weakest advantage was in areas unrelated to VHA performance measurement, where they finished 0 to 10 percentage points ahead of their nearest competitor (55% vs. 50%; difference, 5 percentage points [CI, 0 to 10 percentage points]).

The study results were somewhat limited by unmeasured residual differences in patient characteristics, a lower response rate in the national sample, and differences in documentation practices could have contributed to some of the observed differences.

From the study, the research team concludes that patients receiving socialized, government-run medicine from the VHA received higher-quality care according to a broad measure. Differences were greatest in areas where the VHA has established performance measures and actively monitors performance.

What this study really says is that the more accurately we measure, the more we begin to see that socialized, government-run medical programs like the VA provide extremely high quality medical care.

This study seriously undermines a common refrain of those opposed to healthcare reform, and a strong public healthcare option, that government-run healthcare means poor quality. This recent study of the government-run VA medical system shows that contrary to those doubters, government-run healthcare leads in nearly every measurable category.

So, next time you hear the canard that government-run healthcare will be poor quality, cite the recent VA study that shows just the opposite: Government-run medical care actually leads in nearly every meaningful measure of quality.