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In general, most published studies of comparisons of quality of care show that Veterans getting care from VA get the same or better quality care than Veterans getting VA-paid community care or the general public getting non-VA care.
The Department of Veterans Affairs (VA) is the nation's largest integrated health care system. Comparisons of VA-delivered care to care delivered in non-VA settings are central to assessing the quality of VA care. The VA Office of the Assistant Under Secretary for Health for Quality and Patient Safety requested a systematic review of evidence comparing quality and safety, access, patient experience, and cost between VA and non-VA care settings. The first such review was published in 2010 and 2011, was updated by non-VA investigators in 2017, and was subsequently updated 4 times by the Evidence Synthesis Program in 2022-2024. The current update now includes a comparison not included in the prior reviews, namely a comparison of VA and non-VA care for hospital care of acute medical conditions.
From 3,133 titles, we identified 52 studies of non-surgical care meeting inclusion criteria. From 3,126 titles, we identified 24 studies of surgical care meeting inclusion criteria. Five studies contributed data to both. We further identified a subset of 13 studies about hospital care for acute medical conditions. The majority of included studies assessed quality and safety. Fewer studies assessed other domains of care. In the domain of quality and safety, most studies found that VA care is as good as, or better than, care in the community. For the domains of access and of cost/efficiency, the studies were more evenly distributed between the categories of VA care is better, VA and community care are about the same, and community care is better. The few studies of patient experience found that VA care and community care were about the same, or VA care was better. We did not identify any study that found that patient experience was better in community care. The subset of studies about hospital care for acute medical conditions had results similar to the overall results: with few exceptions, care in VA was as good or better than care in non-VA hospitals.
Shekelle PG, Burke RE, Apaydin EA, Begashaw MM, Wray CM. Quality of Hospital Medicine Care in Veterans Affairs Hospitals versus Non-Veterans Affairs Hospitals: A Systematic Review of Comparative Studies. Journal of Hospital Medicine. 2026; 1-9. DOI: https://doi.org/10.1002/jhm.70351.
Apaydin EA, Paige NM, Begashaw MM, et al. Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic Review. Journal of General Internal Medicine. 2023. DOI: https://doi.org/10.1007/s11606-023-08207-2.
Blegen M, Ko J, Salzman G, et al. Comparing Quality of Surgical Care Between the US Department of Veterans Affairs and Non-Veterans Affairs Settings: A Systematic Review. Journal of the American College of Surgeons. Published online May 8, 2023. DOI: http://doi.org/10.1097/XCS.0000000000000720.
VA versus Non-VA Quality of Care: A Living Systematic Review (Management Brief)
