• Mariah Blegen, Jamie Ko, Garrett Salzman, Meron M Begashaw, Jesus G Ulloa, Mark Girgis, Paul Shekelle, and Melinda Maggard-Gibbons.
• From the Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA (Blegen, Salzman, Begashaw, Ulloa, Girgis, Shekelle, Maggard-Gibbons) University of California-Los Angeles, Los Angeles, CA.
• J. Am. Coll. Surg. 2023 Aug 1; 237 (2): 352361352-361.

AbstractIn response to concerns about healthcare access and long wait times within the Veterans Health Administration (VA), Congress passed the Choice Act of 2014 and the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 to create a program for patients to receive care in non-VA sites of care, paid by VA. Questions remain about the quality of surgical care between these sites in specific and between VA and non-VA care in general. This review synthesizes recent evidence comparing surgical care between VA and non-VA delivered care across the domains of quality and safety, access, patient experience, and comparative cost/efficiency (2015 to 2021). Eighteen studies met the inclusion criteria. Of 13 studies reporting quality and safety outcomes, 11 reported that quality and safety of VA surgical care were as good as or better than non-VA sites of care. Six studies of access did not have a preponderance of evidence favoring care in either setting. One study of patient experience reported VA care as about equal to non-VA care. All 4 studies of cost/efficiency outcomes favored non-VA care. Based on limited data, these findings suggest that expanding eligibility for veterans to get care in the community may not provide benefits in terms of increasing access to surgical procedures, will not result in better quality, and may result in worse quality of care, but may reduce inpatient length of stay and perhaps cost less.

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