Summary: Many veterans have health care needs that are not adequately met through current health care programs, including the Department of Veterans Affairs' (VA) health care system. About one-third of the nation's homeless are veterans, nearly one-half of whom have serious mental problems, suffer from substance abuse, or both. The homeless have limited access to health care services and may not seek medical treatment. About 38 percent of male and 25 percent of female Vietnam veterans with Post Traumatic Stress Disorder have not sought treatment. About 91,000 low-income, uninsured veterans with no apparent health care options indicated in a 1987 VA survey that they had never used VA health facilities because they were unaware that they were eligible or they had concerns about the quality or accessibility of VA health care. VA cannot adequately address many of these health care needs because (1) it relies primarily on direct delivery of health care services in VA facilities, (2) its complex eligibility and entitlement provisions limit the services that veterans can obtain from VA facilities, and (3) space and resource limitations prevent eligible veterans from obtaining covered services. This report presents several options for restructuring VA's health care system to enable it to better meet the health care needs of veterans.
