The Veterans Choice Act and Dual Health System Use

Excerpt

The Veterans Access, Choice and Accountability Act (Choice Act), formally enacted on August 7, 2014, arose largely in response to outrage about delays in veteran access to health care and falsification of wait time records by Veterans Administration (VA) employees.1 The law includes a number of provisions to improve care for veterans, including increasing health care staffing and residency training positions, streamlining employee disciplinary procedures, improving treatment of military sexual trauma, and establishing a Presidential Commission on Care to evaluate access to VA health care. The most well-known, and perhaps controversial, provision is the Choice Program, which established a mechanism for eligible veterans to receive care outside the VA for 3 years. Veterans unable to schedule an appointment within 30 days of their preferred date or who live more than 40 miles from a VA facility are now eligible to receive care from non-VA providers. However, many of these veterans will also continue to use VA facilities and services, and this ‘dual use’ of health care systems may lead to care fragmentation and its ensuing adverse consequences. This commentary describes the problems of dual use and care fragmentation, the complexity of the Choice Program, and some ideas for ensuring its safe and effective implementation. …