Summary: The Department of Veterans Affairs' (VA) health care system began as a network of hospitals established to provide specialty care to veterans with injuries or conditions directly resulting from their military service. Over time, eligibility was expanded to provide both inpatient and outpatient care to low-income veterans for conditions not directly resulting from military service. The Veterans' Health Care Eligibility Reform Act of 1996 was enacted to equip VA with ways to provide veterans with medically needed care in a more equitable and cost-effective manner. The act required VA to establish a system for enrolling veterans for health care and to use this system for managing delivery of services. The act also requires VA to enroll only those veterans for which it has sufficient resources to provide timely health care. However, the waiting times to schedule primary care and specialty care appointments have increased since the beginning of fiscal year 1999. VA's guidelines state that new patients wanting routine care and specialty care patients should receive appointments within 30 days. VA is not consistently meeting these timeliness standards. Some veterans have to wait 150 days to obtain a follow-up appointment with a primary care provider and some specialty care appointments exceed the 30 day average. In making the decision to offer enrollment to veterans within the seven priority groups for fiscal year 1999, VA estimated the number of veterans who would enroll, their need for services, the portion of services they would seek from VA, and VA's expenditures to provide these services under its Uniform Benefits Package. VA then compared its estimated expenditures for the Uniform Benefits Package to the anticipated funding and concluded that it could afford to offer enrollment to veterans in all priority groups. VA will be severely challenged to serve all veterans seeking to enroll in fiscal year 2000 within its proposed budget. VA estimates that it will need $19.23 billion, $870 million more than its estimated fiscal year 1999 spending level of $18.36 billion, to maintain current service levels in fiscal year 2000 if no management efficiencies were realized. VA will need to reduce other expenditures by nearly $1.4 billion in order to effect the increase. VA estimates that it could save about $514 million of this $1.4 billion in personal services savings which means VA would need to reduce its employment level by 8,529 full-time employees. If VA does not realize the $1.4 billion it plans to save in management efficiencies from personal and nonpersonal services, it may have to consider cutting deeper into the priority groups.
