The report is a product of the VA/HSR Evidence Synthesis Program.

VA versus Non-VA Quality of Care: A Living Systematic Review

Takeaway: Most published studies that compare quality of care show that the quality and safety of VA care is as good as, or better than, non-VA care. Findings of a subset of studies that assessed the quality of hospital care for acute medical conditions were consistent with the overall review’s results. Future research is needed to compare the quality of certain types of clinical care (e.g., physical medicine and rehabilitation) in VA hospitals versus community care.

HSR’s Evidence Synthesis Program (ESP) solicits nominations for systematic review topics several times per year from health system leadership. In 2010, the VA Office of the Assistant Under Secretary for Health for Quality and Patient Safety recommended looking at studies that benchmark VA care with the community, or non-VA care. The ESP Center in Los Angeles frequently updates a systematic review of studies that compares the quality of VA and non-VA healthcare and is issuing the latest review, which includes studies through April 2025. The current update includes a comparison not included in prior reviews, namely a comparison of VA and non-VA care for hospital care of acute medical conditions.

Through a search of PubMed, APA PsycINFO, and Web of Science databases from 1/1/2015–4/20/2025, the ESP team identified relevant publications to include in this review: 52 studies of non-surgical care, 24 studies of surgical care, and five studies of both. The team also included a subset of 13 studies that assessed the quality of hospital care for acute medical conditions.

Summary of Findings

• Most of the studies found that the quality and safety of VA care is as good as, or better than, non-VA care.
• Fewer studies examined access to care, patient experience, and efficiency/cost of care. Findings from the available studies are mixed but tend to favor VA care.
• No study found that patient experience was better in community care.
• The findings of the subset of 13 studies that assessed the quality of hospital care for acute medical conditions were consistent with the overall review’s results.

Implications

In general, most published studies that compare quality of care show that care provided by VA hospitals is the same or better quality than care provided in the community. The most recent available evidence supports this conclusion, as does evidence regarding hospital care for acute medical conditions.

Limitations

In addition to the usual limitation of any systematic review (the quantity and quality of the original studies), this review might reflect publication or investigator bias, as most of the published studies were conducted by VA authors. In addition, there was possible confounding due to factors such as Veterans’ higher risk of comorbidities compared to the general population, and the financial incentive for community care providers in fee-for-service systems to code for comorbidities.

Future Research

Studies that compare the quality of VA and community care are needed for a number of types of clinical care, such as physical medicine and rehabilitation.

Citation

Shekelle P, Miake-Lye I, Begashaw M, et al. VA versus Non-VA Quality of Care: A Living Systematic Review. Washington, DC: Evidence Synthesis Program, Health Systems Research, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #05-226; 2025.

To view the full report, go to https://www.hsrd.research.va.gov/publications/esp/va-non-va-care.cfm.

How can VA leadership work with the ESP? Nominations for systematic review topics may be submitted to the program at any time. When you submit a topic nomination form, ESP Coordinating Center staff will work with you to determine the appropriate research approach and ESP product to address your questions of interest. Topics are selected and assigned to an ESP Center based on program capacity and alignment with VA national goals.

This Management Brief is provided to inform you about recent HSR findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR Resource Center charged with disseminating important HSR findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of VA/HSR's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers, and to disseminate these reports throughout VA.

See all reports online.