Three Essays on Veteran Health Policy

It is a solemn obligation to provide high quality healthcare to veterans who sacrificed themselves to protect their country and democratic values. Although the Veterans Health Administration (VHA) has conducted numerous highly regarded research on veteran health policy, there is still a great amount of work to be done to provide high quality care to veterans at affordable cost. This dissertation strives to better understand veteran health policy and to provide constructive suggestions for the Veterans Health Administration. The first essay explores the expected effects of the repeal of the individual health insurance mandate on veterans’ access to private and VA insurance by analyzing 52,692 non-elderly veterans in Florida and California from 2008 to 2017. The findings suggest that the repeal will lead to a considerable increase in the number of uninsured veterans and veterans who are unemployed, poor, and suffering disabilities are more likely to sign up for the VA insurance than better off veterans. The second essay evaluates technical efficiency scores of the VA hospitals and investigated the effect of the Veterans Choice Act of 2014 on the VA hospitals’ technical efficiency. The findings show that overall technical efficiency of the VA hospitals decreased after the implementation of the Act which authorized veterans’ use of non-VA hospitals. The magnitude of the decrease was in proportion to the number of veterans using non-VA hospitals under the Act. This suggests that the VHA should evaluate whether current capacity of the VA hospitals is appropriate and try to reduce wasted input resources. The third essay examines how technical efficiency, along with other factors, influences quality of care in VA hospitals. The findings show that high technical efficiency, a low nurse turnover rate, and a low preventable hospitalization rate lead to a decrease of both mortality and readmission. Conversely a high percentage of veterans using the Veterans Choice Programs (VCPs) leads to an increase in the mortality. These findings suggest that the VHA should improve coordination within the VA healthcare system, reduce nurse turnover, construct an integrated patient information exchange system between VA and non-VA hospitals, and increase veterans’ access to primary care. This dissertation is meaningful to existing literature on health policy in that it is the first dissertation that examined veteran health policy from perspectives of access, cost and quality. In addition, this dissertation suggests several substantial recommendations for practitioners in the VA and the VHA.