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VA Health Systems Research

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

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

Recommended citation:
Shekelle P, Maggard-Gibbons M, Blegen M, et al. VA versus Non-VA Quality of Care: A Living Systematic Review. Washington, DC: Evidence Synthesis Program, Health Services Researchand Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #05-226; 2023.

Download PDF: Complete Report, Executive Summary, Report, Appendices


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) Veterans Health Administration (VHA) is the nation's largest integrated healthcare system. Comparing the quality of VA-delivered healthcare to care delivered in non-VA settings is one way of ensuring VA maintains its commitment to providing high-quality care to Veterans. To support this aim, the VA's Evidence Synthesis Program (ESP) systematically reviews studies comparing the quality of VA and non-VA healthcare. The ESP report available here is frequently updated with the most recently available evidence; the current report was previously updated in April 2023.

Key Findings

From 2,598 titles, we identified 42 studies of non-surgical care meeting inclusion criteria. From 2,591 titles, we identified 19 studies of surgical care meeting inclusion criteria. Four studies contributed data to both. 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 the found that patient experience was better in community care.

See also

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:

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:

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