Who is more efficient in health care? Study Reveals, Surprisingly, It’s the VA

Private sector hospitals, clinics and insurers are bloated bureaucratic nightmares compared to efficiently run facilities by the Veterans Health Administration that prioritize profits, a new study finds.

The study, by researchers at Hunter College of the City University of New York, Harvard Medical School, the Veterans Health Administration and the University of Washington, points the finger at private, for-profit institutions and insurers , where 30% of the staff is stuck in the tangle of paperwork, while the VHA shines with an administrative staff reduced to 22.5%. That means nearly 900,000 fewer paper pushers would be needed if private hospitals, clinics and insurers took their cues from the VHA manual.

The research is published in the journal Open JAMA Network.

Much of the increase comes as profit-seeking insurers try to avoid paying for care by imposing complex rules and documentation requirements.

“Our profit-driven system rewards providers who devote more resources to gaming the payment system,” said lead author Dr. Steffie Woolhandler.

Private sector providers can increase profits by investing in administrative activities such as marketing and upcoding (adding irrelevant diagnoses to bills) that increase revenue but have no clinical value.

This is not the case at VHA, where recent studies have shown that care is on average better than that in the private sector.

“At VHA, caring for our patients – not money – is at the center of our mission,” said Dr. Andrew Wilper, chief of staff of the Boise, Idaho, VHA and associate professor of medicine at the University of Washington. “We strive to care for those who have served in our nation’s military as well as their families, caregivers and survivors.”

Researchers analyzed employment and occupation data from a Census Bureau survey of 3.2 million Americans, including 122,315 who worked in the private sector and in hospitals, clinics and doctor’s offices across the country. VHA.

They grouped all health care professions into 18 categories, including three administrative categories, and applied the same classification criteria to VHA and private sector health care workers. They supplemented the Census Bureau survey with Bureau of Labor Statistics data on health insurance employees and detailed VHA personnel records.

Woolhandler and Himmelstein are internists, distinguished professors at CUNY’s Hunter College and professors of medicine at Harvard Medical School. Study co-authors Andrew Toporek, Jian Gao and Eileen Moran work in VHA’s Office of Productivity, Efficiency and Staffing, Quality and Patient Safety, Office of Performance Analysis and Integration, of which Moran is director. Wilper is an internist and practice manager in the Boise, Idaho VA.

VHA’s 171 medical centers and 1,113 outpatient care sites care for approximately 9 million enrolled veterans. VHA hospitals and clinics receive flat-rate budgets covering almost all of their operations, similar to how fire departments are funded. Federal government appropriations represent approximately 97% of the VHA budget; 2.7% is paid by private insurers and 0.3% by patients themselves.