(HealthDay)—The Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act may increase costs and reduce quality of health care for veterans, according to an Ideas and Opinions piece published online July 24 in the Annals of Internal Medicine.

Joel Kupfer, M.D., from the University of Arizona College of Medicine-Phoenix, and colleagues discuss the VA MISSION Act, which is designed to offer greater choice based on networks of community providers. As services and facilities are eliminated, the VA’s ability to operate as a health care provider could be diminished, resulting in de facto privatization.

The authors note that greater choice in health care is perceived as positive. However, the extent to which greater reliance on private sector care will improve veterans’ health status will depend on the costs, access, and quality of care. A crude estimate suggests that VA costs of care averaged $7,974 per enrollee in 2017 versus $10,348 per capita in U.S. national health expenditures and $12,046 per beneficiary in Medicare expenditures in 2016. VA facilities often outperform non-VA facilities in parameters of good inpatient care and ambulatory measures. Greater reliance on private sector care will increase the number of VA and non-VA care users, a factor associated with worse health outcomes.

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