The veterans health care system reform

The veterans health care system reform
American Veterans health Care System (the Veterans Affairs health Care System) is the only directly by the government to provide services in the United States health Care System, the government by congress to approve tax of its funding, facilities of the state, medical institutions personnel for government employees, from the Department of Veterans Affairs (Department of Veterans Affairs) of the Veterans Affairs medical Affairs management.In the 1980 s and early ninety s, it's bureaucracy, such as low efficiency and treatment level of general, privatization of veterans health care system.Launched in 1995, the veterans health care system reconstruction plan, began to reform in an all-round way.More than a decade, the United States veterans health care system has become the largest integrated health care system, centered on patients, high quality, high value of the characteristics of medical services, make it become the world's most effective public hospital system, is other learning model for the health care system.

American veterans health care system functions play four main functions: the veterans health care system to provide medical and health services, teaching, scientific research, and to assume the government's medical emergency task.(a) at the beginning of the health service set up, veterans health care system is only for the war wound disabled veterans provide medical services.In 1990, less than 10% of injuries disabled veterans medical service system, 90% of the veterans have other health insurance.But its service gradually expand to other veterans, mostly low-income and displaced persons.In 1995, only 12% of the patients was disabled in the war wounded veterans, but there are also 28%

Patients was disabled in the war wounded veterans, but they are not for the disabled in the hospital, the remaining 59% of the patients did not wound disabled in the war, mainly low-income veterans.So the system became an important part of health care network, and undertake the responsibilities of a social safety net, actually.After the reform, the qualification for veterans hospital services determined from strict authentication system to the registration system.Because of budget constraints, not provide all the required services for all registered person, so according to the degree of disability disease associated with serving, severity of the disease, registrant of economic conditions, such as standard, the registered person is divided into eight priority group, under the constraint of the budget in accordance with the priority to provide medical and health services, priorities of the need to pay higher co-payments.

(2) medical education and training of veterans health care system to accept every year 34000 residents and 22000 medical students in internship, 125 medical college in 107 and 131 by veterans affairs medical center has the teaching agreement, an estimated 65% of the doctors are trained veterans health care system.Medical research, 1958 (3) veterans health care system in accordance with the requirements of the U.S. congress, began to conduct medical research work, including research in all directions, the government invests a lot of money to support, at the same time, the participation of private funds have contributed to the veterans health care system of medical research.(4) the government's health emergency treatment in 1982, the veterans health care system in accordance with the requirements of the U.S. congress began and undertake processing and other emergency system of emergent public health events, natural disasters and other events of emergency medical and health care.

American veterans health care system reconstruction scheme in 1995, the veterans affairs medical affairs bureau began to reconstruct veterans health care system reform.Reform is on the one hand due to bureaucratic phenomenon is serious, such as inefficient, treatment level of general performance make it criticized;On the other hand is financial pressure.Health care spending is increasing, while the government finances can't keep up.Although the decrease in the total number of veterans, but because of an ageing population, medical expenditures rise quickly;In reducing the federal government spending, reduce the fiscal deficit, under the macro policy of veterans health care system of the government budget in 1977 accounted for 5% of the federal budget down to 2.5% in 1996.Congress did not veterans health care system reform to the American public debate on health reform, but to make its independence to reform.The director Kenneth w. Kizer proposed "from hospital system to medical systems (from a hospital system to a health care system)".Major reforms
Features are: change the organizational structure and governance structure, optimize the allocation of resources, management, assessment of the quality and effect, and provide support for the patients, medical staff and regulators of the information system.

A) organizational structure adjustment, realize the regional integration in 1995, the veterans health care system contains about 173 hospitals, 600 outpatient clinics, 133 nursing institutions, 40 206 rehabilitation institutions and consultation center.After the reform, 173 veterans hospital merger to 22 regional integration service network (VISN), its internal resources can be Shared human and equipment (two network has also been merged, so the existing 21 network).Through regional integration, regional medical services can be more flexibility and operability, timely reflect the different needs of patients with local area network, adopting reasonable solution.For example, post-traumatic stress disorder (PTSD), veterans health care system area network can be adjusted timely to this kind of special disease diagnosis and treatment process.

(2) governance structure adjustment, the management and supervision of the separation reform, veterans affairs medical affairs bureau is responsible for the overall planning and policy making, and direct management of the hospital, so the management team.Veterans health care system of employees ranked third in the federal government agencies, streamlining staff is a strong demand from the outside.After the reform, from to is mainly responsible for policy making, the long-term goal of the system planning and to develop guidance, responsible for the supervision and examination of various regional integration service network, and shall be responsible for congress.At the same time, simplify the management of the affairs personnel, 25% attrition.Area network, director of the national network of responsibility for the operation, budget and decision-making.

(3) budget mode, mode of payment change before the reform, the government report of the previous year's spending budget according to the hospital, the veterans health bureau to grant 173 hospitals.For hospitals, the more spending, after is, the more money, have no incentive to control costs.After reform, according to the past no longer spending on the budget, but according to the budget estimate of the cost of every veterans, grants follow patients, and capitation payment, this incentive hospital service more people, and must control the cost.Veterans affairs medical affairs bureau under the supervision of the congress, funding for 22 area network.1997 veterans demand resources after the construction of the distribution system (VERA), through the data analysis, categorizing the crowd of different requirements, main need of basic medical services and the main difference between two groups the special medical services, for a better budget.

(4) medical pattern adjustment, service content reform
Before the reform, veterans health care system mainly provide service in hospital.Under the trend of the development of the management of health care in the United States is a strong, veterans health care system to provide preventive health care, more basic medical service and health management, moving in the compound of community-based mutual medical network development.Through the establishment of more outpatient clinics and mobile clinics, make its service people can be more convenient access to medical services.At the same time, the veterans health care system able to persuade the government expands services to more veterans groups, and the health of the community as a standard of performance appraisal.After the reform, the outpatient service toll, a decline in the hospital, the reason is that the proportion of the chronic diseases and nursing rehabilitation increased, at the same time supporting services: including nursing station, counseling centers and number of institutions in the rehabilitation center.

(5) the quality and value as a development strategy, establish assessment and accountability system due to the public nature of veterans health care system, this system is also the most critical departments, in the ninety s, the veterans health care system by many critics, even made in Hollywood movies.So after reform will have on the quality and value as a development strategy, take the objective evaluation of the quality and value as a means of internal performance improvement, and as the basis of internal and external accountability.Made the measure of quality and value in the reform, and to evaluate.Value with the technology level of medical services, service convenience, treatment effect, the patients' satisfaction, the overall health of the community five output index and medical costs the input index to measure and analyze the effect of the input and output.Veterans affairs medical affairs department responsible for the congress, veterans health care system between various levels also have signed an agreement of the quality of accountability, such as each part of the veterans affairs medical treatment and the director of the network accountability agreement.

(6) the construction of information sharing system of veterans health care system successfully implemented to improve the way of management model, reform the budget, optimizing the allocation of resources and improving the service quality and value is the important basis of a Shared information system is established.The department of veterans affairs (VA) since 1985, for the convenience of medical management and automated information system is established, first hospital computer program system for decentralized, has a wide range of clinical and management performance.In 1997 began using electronic medical record system (CPRS), greatly improved the function of the original system.Reform set up after the veterans health information system and the technical architecture (VistA) to realize the information sharing, not only help the doctor make reasonable medical decisions, but also provide support to improve the performance and implementation of health management.Veterans health information system and the continuous improvement, toward the more perfect sharing information platform development, including 1) patient centered health records system;2) services for the center with your health care provider and evaluation system;3) with the modern enterprise financial management system as the core of financial management system.

Fourth, the American legion the effect of the medical system reform
Veterans health care system reform has achieved remarkable success after, become one of America's most dynamic medical system, caused the wide concern policy circles and academia.In recent years, the system is evaluated both efficiency and cost of medical services in the best group.After reform, veterans health care system with relatively fewer resources to treat more patients, more than 77% of the patients get effective basic medical treatment service.The more veterans willing to sign up.In recent years, the American legion in reducing population, from 26.5 million to 23.5 million in 2000, but the veterans health care system in the registration number is on the increase, from $1999 in 4.3 million to 7.9 million, actually obtains the number of medical and health services will increase, from $1995 in 2.9 million to 2006 in 5 million.But the veterans health care system to sort out the medical expenses of flat growth rate, up from $1996 in 17 billion to $2006 in 32 billion, compared with other American medical system, the system cost control is the best.At the same time, the veterans health care system to become industry leaders, medical information, performance improvement in its patient satisfaction and 18 on disease prevention and treatment of indicators as the national standards.

Five, the American veterans medical system reform of our country's enlightenment American veterans effective health care system reform scheme and process of medical and health system reform in our country, especially the reform of public medical service system in China has great reference significance.1, the public medical system not only provides medical and health services, but also an important force in medical education, scientific research, and more of the functions of the medical treatment, is an important guarantee of national emergency event handling.2, unified integrated public medical system, not only has economies of scale and scope economy effect, able to provide cost effective management and control, and for the use of modern information and management provides the basis.3, public medical institutions need to refactor, but also the public medical system can through the adjustment of organizational structure and management system, such as resource allocation way of improving the value of the reform, improve the efficiency and service.4, medical service should be toward to patients as the center, in the direction of health as the center, so the organization form of the content of the medical service, medical institutions should be in this direction.5, the establishment and perfection of the information system is the important guarantee of successful reform.