Eligible U.S. veterans 65 years of age or older may receive health care funded either by the Veterans Health Administration (VHA) or by the Health Care Financing Administration (HCFA) under Medicare. Some believe that patients cared for in VHA institutions receive poorer quality care than those cared for in non-VHA institutions, but data are lacking to prove or disprove this belief. A recent study, supported by the Agency for Healthcare Research and Quality (HS08071), finds that veterans treated at VHA hospitals have similar outcomes for heart attacks as male Medicare beneficiaries treated at non-VHA hospitals.
The researchers compared the coexisting medical conditions, severity of illness, and outcomes of 2,265 matched pairs of heart attack patients treated in VHA and non-VHA hospitals using nationally representative clinical data. They compared survival among those who were treated within the VHA system and those who were not, within each type of hospital, and in each 5-year age group. VHA patients had more coexisting conditions and were much more likely than Medicare patients to have a history of hypertension (64 vs. 57 percent), chronic obstructive pulmonary disease or asthma (31 vs. 24 percent), diabetes (35 vs. 29 percent), stroke (20 vs. 14 percent), or dementia (7 vs. 5 percent).
The use of thrombolytic (clot-busting) agents was similar in both groups. However, more VHA than Medicare patients were receiving beta-blockers, angiotensin-converting-enzyme inhibitors, or aspirin at discharge, which at least partly accounted for similar outcomes with less ill Medicare patients. After adjusting for differences in medical risks between the two groups, the researchers found no significant difference in 30-day or 1-year mortality, suggesting similar quality of care for both groups of veterans.
For more details, see "Outcome of myocardial infarction in Veterans Health Administration patients as compared with Medicare patients," by Laura A. Petersen, M.D., M.P.H., Sharon-Lise T. Normand, Ph.D., Jennifer Daley, M.D., and Barbara J. McNeil, M.D., Ph.D., in the December 28, 2000, New England Journal of Medicine 343(26), pp. 1934-1941.