This week's Time has the story How VA Hospitals Became The Best. Kinda surprising but also cool. Kevin Drum wrote about it and refers to a year old article in the Washington Monthly by Phillip Longman called The Best Care Anywhere.
Apparently in the last 12 years the VA has changed a lot mostly due to Undersecretary Kenneth Kizer who Clinton appointed in 1994. " He oversaw a radical downsizing and decentralization of management power, implemented pay-for-performance contracts with top executives, and won the right to fire incompetent doctors. He and his team also began to transform the VHA from an acute care, hospital-based system into one that put far more resources into primary care and outpatient services for the growing number of aging veterans beset by chronic conditions...It also involved an obsession with systematically improving quality and safety that to this day is still largely lacking throughout the rest of the private health-care system."
They have very high tech records keeping with laptops and bar codes on patients and drugs and a nationwide database with complete patient records that track the life of the patient not just their visits with one doctor. Longman's article describes how the current pseudo-private system doesn't support a business case for quality care and it makes a lot of sense. I've been saying for a long time that health care isn't a good free market system because the buyer is not knowledgeable and can't evaluate health care choices.
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