Components of medical care
The Veterans Affairs health care system is one of the most inclusive health care organizations in the United States. It therefore offers the perfect framework for assessing the features of health care services offered to huge numbers of patients with chronic conditions (Krein, Bingham, McCarthy and Mitchinson, 2006, p.1016). Of the three fundamental elements of medical care – structure, process and outcome – the outcome is the most important for the Veterans Affairs health administration. The VA should therefore focus more on the outcome than on the structure and process of medical care. Outcome of medical care symbolizes the impact that medical care has on the patients and the entire population. The outcome of medical care is measured by several indicators such as: enhancement of the patients’ understanding of their medical conditions, their satisfaction with the health care system, their degree of wellbeing, the functional status as well as the level of mortality and morbidity (Spiegel and Hyman, 1991, p.345). On the other hand, the structure of medical care symbolizes the characteristics of the health care organization. The characteristics include the availability (or lack thereof) of health care facilities, the quality of the facilities, the quality and quantity of the organization’s staff, and the organization of both the material and human resources. The process of medical care represents the manner in which care is provided to the patients. It comprises of the actions taken by both the patients in looking for care and the actions taken by health care providers in providing care to the patients. These actions include: “diagnostic procedures, laboratory tests, surgical interventions, and level of nursing care” (Spiegel and Hyman, 1991, p.346).
The VA health care organization should concentrate on the outcome of medical care for a number of reasons. First, the outcome is the ultimate goal of any health care organization (Spiegel and Hyman, 1991, p.345). It is therefore a reflection of the entire health care organization. It reflects the structure of the health care organization; that is, whether or not the organization is structured in a manner that will provide the utmost health care services to the most needy patients at an affordable cost. The outcome of medical care reflects on the quality of the organization’s facilities. A good outcome shows that the health care organization has adequate and high-quality facilities and resources. The outcome also shows the quality of the organization’s staff. A good medical care outcome is a proof that the organization has adequate and well-trained staff. Second, the outcome is a reflection of the process of medical care. It indicates whether or not the patient sought medical attention on time as well as his attitude towards the entire health care system. It also shows whether or not the medical staff of the organization followed an appropriate channel in the provision of quality medical care to the patient. That is, accurate and timely diagnosis, accurate laboratory tests, accurate medical intervention through surgery or medications and adequate medical care during the recuperating process. As a result, the outcome is the most important element of medical care.
In the United States, the provision of medical care to the veterans by the Veterans Affairs health care system is governed by a number of legislations. One of these legislations is the Veterans Millennium Health Care and Benefits Act. This Act was assented to in 1999 (Berkman and D’Ambruoso, 2006, p.617). The main objectives of this Act is to make available additional health care services to veterans, to upgrade the existing health care services provided the VA to the veterans and to improve on the reimbursement, housing and retirement benefits of veterans. The Act has eleven chapters, four of which concern the provision of health care to veterans. The first chapter is dedicated to the access to health care by the veterans.
The chapter lays out the criteria to be followed by the VA in the provision of additional health care services to veterans and in the compensation of veterans seeking urgent medical attention in non-VA health care organizations. It also extends the health care provided to veterans who have been wounded in the war fields, and the veterans who are dependent on drugs and alcohol. Most importantly, it extends health care services to veterans who have experienced sexual abuse and those suffering from mental illnesses. The second and third chapters deal with the administration process of the VA’s medical program. It lays out the process to be followed in the collection of funds, the utilization of such funds, the appropriation of the funds, the allocation of medical facilities and the employment of medical staff at the VA health care facilities. The fourth chapter deals with issues relating to the health care facilities of VA. According to Berkman and D’Ambruoso, this chapter “contains provisions relating to the authorization of major medical facility projects, the authorization of major medical facility leases, and the authorization of appropriations,” (2006, p.618)
Outcome of medical care at the VA health care system can be measured in different ways. The inpatient and outpatient use of the medical facilities by the veterans is a good measure of outcome. Inpatient care can be measured by the number of patients who are hospitalized within a given period of time, as well as the mean length of hospitalization for each patient. Outpatient care can be measured by the number of patients who visit the VA’s health care facilities on a particular day as well as the standard number of visits for each patient. A high inpatient and outpatient utilization of the VA’s facilities indicates that the veterans have confidence in their health care system. It also shows that the health care system is adequately equipped to meet the health needs of the patients. Most importantly, it indicates that the process of receiving care is efficient. Most veterans suffer from severe medical conditions such as mental illnesses and functional disabilities. As a result, high inpatient utilization shows the commitment of the health care system in providing much-needed health care attention to the veterans rather than leaving them on their own to tend to their needs (Uphold et al., 2004, p.552).
The outcome of medical care provided by the VA can also be measured by the impact of rehabilitation provided to injured veterans. Siddharthan, Scott, Bass and Nelson argue that, “returning soldiers from Iraq and Afghanistan who have sustained polytrauma have a combination of complex physical and mental morbidities that require extensive therapy and rehabilitation,” (2008, p.221). The rehabilitation program of the VA health care system aims at recognizing the veterans suffering from polytrauma, offering comprehensive medical examination, offering therapeutic, rehabilitative, and mental cure services, as well as supervising temporary and permanent patient results. Because polytrauma affects both the functional and cognitive abilities of the veterans, the outcome of the rehabilitation program can be assessed using the functional and cognitive status of the veterans who have undergone the rehabilitation program. A positive outcome indicates an effective structure of the rehabilitation program as well as an effective process in the provision of the rehabilitative services to the veterans. This includes close supervision of the veterans, coordination of care among the health care practitioners and specialists and effective pain management strategies (Siddharthan, Scott, Bass and Nelson, 2008, p.224).
Access to care is an important measurement of the outcome of medical care. It is especially a strong indicator of the structure of any health care organization. This is because the structure of a health care organization has great implications for the availability of medical services to the vulnerable population and the costs of obtaining medical services. An organization with few medical staff, few resources and expensive services may hinder many patients from accessing much-needed medical services. In the VA health care system, priority is often given to patients with the utmost medical needs but with little or no alternatives. However, the access to such care is not always guaranteed for such patients. Indeed, research shows that some veterans with severe medical conditions such as those with bipolar disorder find it difficult to access essential medical care, particularly specialist care. Access to care also differs in homeless veterans from residential veterans. Homeless veterans have great barriers in accessing care due to costs issues and problems in monitoring and supervision by health care practitioners (Zeber et al., 2009, p.726). All these measures of outcome provide a great insight into the structure of the health care organization and the process followed in providing medical care to patients.
- Berkman, B., and D’Ambruoso, S. (2006). Handbook of social work in health and aging. Oxford: Oxford University Press.
- Krein, S.L., Bingham, C.R., McCarthy, J.F. and Mitchinson, A. (2006). Diabetes treatment among VA patients with comorbid serious mental illness. Psychiatric Services, 57.7, 1016-1020.
- Siddharthan, K., Scott, S., Bass, E., and Nelson, A. (2008). Rehabilitation outcomes for veterans with polytrauma treated at the Tampa VA. Rehabilitation Nursing, 33.5, 221-225.
- Spiegel, A., and Hyman, H. (1991). Strategic health planning: Methods and techniques applied to marketing and management. Santa Barbara: Greenwood Publishing Group.
- Uphold, C.R., Deloria-Knoll, M., Palella, F.J., Parada, J.P., et al. (2004). US hospital care for patients with HIV infection and pneumonia: The role of public, private, and Veterans Affairs hospitals in the early highly active antiretroviral therapy era. Chest, 125.2, 548-556.
- Zeber, J.E., Copeland, L.A., McCarthy, J.F., Bauer, M.S., and Kilbourne, A.M. (2009). Perceived access to general medical and psychiatric care among veterans with bipolar disorder. American Journal of Public Health, 99.4, 720-727.