Summary: During the last decade, hospital use by the Veterans' Health Administration's (VHA) has dropped about 58 percent, or by 28,000 patients a day. It is expected to continue to decline during the next 20 years, primarily because of a projected 36-percent decrease in the veteran population. About one in three VHA hospitals serves markets with the highest declines in the veteran population and the lowest VHA hospital utilization. VHA's limited progress toward establishing an asset realignment process needlessly delays the reinvestment of scarce resources to enhance veterans' health care. Potential shortcomings in VHA's proposed process--locally led steering committees that have heavy stakeholder--involvement do not instill confidence that VHA will be significantly closer to having a restructuring plan by this time next year than it is today. It seems that a better option would involve a more centralized planning model that is based on consultant or field information and that is free from undue influence from local stakeholders. Without firmer leadership, VHA might take many years to decide on, much less accomplish, systemwide asset realignment. The daily cost of unduly delayed decisions is unacceptably high, given that the Department of Veterans' Affairs could be spending $1 million or more a day to operate and maintain unneeded assets.
