Veterans Affairs hospital system

Definition

The Veterans Affairs hospital system, formerly known as the Veterans Administration hospital system, operates 153 medical centers, more than 700 community clinics, 136 nursing homes , and 43 residential rehabilitation treatment programs in the United States, its territories, and abroad, that provide medical care for veterans of the United States armed forces.

Description

Commonly known as VA hospitals, the Veterans Affairs hospital system is part of the U.S. Department of Veterans Affairs, a cabinet-level agency. There is at least one medical center in each state, the District of Columbia, and Puerto Rico. The VA medical system operates clinics in all states and territories along with a clinic in the Philippines. More than 5.3 million people received care in 2005 in VA health care facilities, a 29% increase from 2001. That number was expected to increase due to the wars in Iraq and Afghanistan that were ongoing as of 2008. Projections are that in 2009, the VA system will treat about 6.8

million people. It is the largest health care system in the United States. VA medical centers are also at the forefront of medical research in such war-related conditions as Agent Orange exposure, Gulf War syndrome, and post-traumatic stress disorder. Its research extends into conditions that affect the general population, including diabetes and HIV/AIDS. Many VA medical centers are affiliated with university medical schools. For example, the VA Medical Center in La Jolla, California, which serves San Diego County, is located adjacent to the University of California, San Diego's (UCSD) School of Medicine. The VA and UCSD medical centers cooperate in numerous research and treatment ventures. A number of new VA facilities and expansions have been approved or proposed for construction through 2012 across the U.S. Of the system's 153 medical centers (as of early 2008), 12 are in New York, 10 are in California, and six are in Texas.

The first hospital for war veterans was Hand Hospital, established in 1778 in Pittsburgh. Other medical facilities followed, including the Naval Home in Philadelphia (1812), and two facilities in Washington, D.C., Soldier's Home (1853) and St. Elizabeth's Hospital (1855). The Veterans Administration was created in 1930 by consolidating several agencies that administered services for veterans. By 1930, there were 54 VA hospitals. Demand for medical care grew substantially in the 1930s, fueled primarily by an epidemic of tuberculosis , and the number of VA hospitals continued to grow. In 1946, the VA's Hines Hospital became the first VA facility to partner with medical schools (Northwestern University and the University of Illinois). By 1946, a year after World War II ended, the VA was operating 97 hospitals with a total bed capacity of 82,241. Another 25 VA hospitals were under construction or planned, along with additions to 11 existing facilities. Despite this, VA hospitals were filled to capacity by the end of 1946 and nearly all hospitals had waiting lists for admission. During 1946 and 1947, 29 new VA hospitals opened, bringing the total to 126.

The 1950s and 1960s brought two wars (Korea and Vietnam) and new challenges to health care for veterans. A special medical issue of the Vietnam War was the health problems that resulted from exposure to Agent Orange. Since 1978, the VA has offered special access to medical care, including physical exams, to Vietnam veterans with Agent Orange health concerns. The VA in 1981 established a special eligibility program which provided free follow-up hospital care to Vietnam veterans with any health problems whose cause was unclear.

By the 1970s, burdened with a growing number of casualties from the Vietnam War, the VA hospital system began to break down. Hospitals were aging and were short of doctors, nurses, and specialists and many lacked up-to-date medical equipment. Many hospitals fell into disrepair and were literally falling apart. Infestations of rodents and cockroaches, and unsanitary conditions were reported at many facilities. The problems prominently came to the attention of the American public when a paralyzed Vietnam veteran, Ron Kovic, ended up in the VA's hospital in the Bronx, New York. He documented the dirty, rat-infested hospital and sub-standard medical care in his best-selling 1976 book, Born on the Fourth of July, which was later made into a movie of the same name. Over the course of the next decade, the VA began revitalizing its hospitals and making improvements in its medical staff. To meet the special needs of its increasing number of older veteran patients, the VA in 1975 began to train interdisciplinary teams of healthcare specialists. Congress in 1980 authorized Geriatric Research, Education and Clinical Centers (GRECCs) to coordinate in the field of geriatric medicine. Late in the 1980s, VA dedicated resources to serving homeless and chronically mentally ill veterans. It also responded to the growing numbers of patients with HIV/AIDS with special treatment units and special training for medical staffs.

Following Operation Desert Storm in 1991, many veterans returning from Iraq, Kuwait, and other war staging areas, complained of symptoms with no readily identifiable cause. The symptoms included fatigue, skin rash, headache, muscle and joint pain, memory loss and difficulty concentrating, shortness of breath, sleep problems, gastrointestinal problems, and chest pain. Scientists examining symptoms of the undiagnosed Gulf War illnesses concluded that there was no single disease or illness affecting Gulf veterans. VA nevertheless initiated a number of research studies to determine the health consequences to veterans of military service in the Gulf War. A number of possible causes for the symptoms have been under examination, including chemical and biological warfare agents, as well as smoke from oil well fires, vaccinations (such as the anthrax vaccine), infections, chemicals, pesticides, microwaves, and depleted uranium which the U.S. military used in munitions. As of 2008, the cause or causes of Gulf War Syndrome were still being disputed by the military and medical researchers.

In 1997, the Women Veterans Health Program Office was established within the Office of Public Health and Environmental Hazards and the first full-time director of the program was appointed. The VA established eight Comprehensive Women's Health Centers and four Stress Disorder Treatment Centers across the country. Also in 1997, the VA began establishing community-based outpatient clinics across the country to increase access to localized health-care. Since 1998, veterans who served in a combat zone or in comparable hostilities have been eligible for free VA hospital care, outpatient services, and nursing home care for two years after leaving active duty for illnesses and injuries that may be the result of their military service.

KEY TERMS

Agent Orange —A toxic herbicide sprayed by the U.S. military during the Vietnam War to defoliate jungle areas and expose enemy forces.

Geriatric medicine —A field of medicine that specializes in the care and treatment of the elderly.

Gulf War syndrome —A multi-symptom illness of unknown causes that affected veterans of Operation Desert Storm, a war to free Kuwait of Iraqi occupation in 1991.

Post-traumatic stress disorder —A psychological condition affecting people who have suffered severe emotional trauma as a result of an experience such as combat and causing sleep disturbances, flashbacks, anxiety, tiredness, and depression.

Viewpoints

In the early 1990s, the care at VA hospitals was so bad that Congress was considering closing the facilities and giving veterans vouchers for care at private hospitals and clinics, according to a Sept. 4, 2006, article in Time magazine. Since the mid-1990s, services at VA hospitals improved drastically, and from 2000 to 2005, VA hospitals scored higher than private hospitals on a patient satisfaction survey conducted by the University of Michigan. By 2005, the VA hospital system had become recognized as one of the nation's premier health care systems, with top primary care doctors, specialists, researchers, nurses, and support staff. It also provided state-of-the-art medical care with the latest diagnostic equipment and treatment techniques. In 2005 and 2006, three of the nation's top news magazines, Time, Fortune, and U.S. News & World Report all carried articles lauding the VA hospital system as a leader in care and technology.

Resources

BOOKS

Budahn, P.J. Veteran's Guide to Benefits Mechanicsburg, PA: Stackpole Books, 2005.

Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides. Veterans and Agent Orange: Update 2006 Washington: National Academies Press, 2007.

Lee, Harry, and Edgar Jones. War and Health: Lessons from the Gulf War Hoboken, NJ: Wiley, 2007.

Roche, John D. Veteran's PTSD Handbook: How to File and Collect on Claims for Post-Traumatic Stress Disorder Dulles, VA: Potomac Books, 2007.

PERIODICALS

Gearon, Christopher. “Military Might: Today's VA Hospitals are Models of Top-Notch Care.” U.S. News & World Report (July 18, 2005): N/A.

Ritter, Ben. “Viva, VA Care!” Paraplegia News (August 2007): 12(3). Stires, David. “Technology Has Transformed the VA.” Fortune (May 15, 2006): N/A.

Waller, Douglas. “How Veterans' Hospitals Became the Best in Health Care.” Time (September 4, 2006): N/A.

Zigmond, Jessica. “Fixing Veterans' Care; Payment, Disability Systems Seen as Key.” Modern Healthcare (August 6, 2007): 14.

ORGANIZATIONS

Veterans Health Administration, 810 Vermont Ave. N.W., Washington, DC, 20420, (202) 273-5400, (800) 827-1000, http://www.va.gov.

Ken R. Wells