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Publication Briefs

Study Shows Veterans Experience Better Outcomes in VA Hospitals for Some Conditions, but at Higher Cost

Many of the 9 million Veterans enrolled in the VA healthcare system have access to non-VA care through VA-purchased services from community providers or concomitant enrollment in insurance programs. VA has long purchased community care when services could not be provided on site, but the Choice Act in 2014 and the MISSION Act in 2018 expanded purchased care for Veterans experiencing access barriers. These policies increased the use of non-VA care and decreased the use of VA services. This observational cohort study compared outcomes for six acute conditions in VA and non-VA hospitals for VA enrollees of all ages in 11 states (n = 414,861; mean age 75 years) discharged between 1/1/2012 and 12/31/2017. Using VA and all-payer discharge data, investigators conducted cross-sectional analysis of hospitalization records for acute myocardial infarction (AMI), coronary artery bypass graft (CABG), gastrointestinal (GI) hemorrhage, heart failure (HF), pneumonia, and stroke. Outcomes included 30-day mortality, 30-day readmission, length of stay (LOS), and costs.


  • Veterans in VA hospitals experienced lower 30-day mortality for heart failure and stroke and lower 30-day readmission for CABG, GI hemorrhage, HF, pneumonia, and stroke compared to Veterans in non-VA hospitals, although differences for GI hemorrhage and HF were found only in patients younger than 65 years. However, Veterans in VA hospitals also had longer mean LOS and higher mean costs for most conditions.  
  • Younger patients hospitalized for AMI in VA hospitals had a higher probability of readmission than non-VA patients. However, costs of AMI hospitalizations among younger patients were lower in VA than non-VA hospitals.
  • VA hospitalizations were more likely to be for Black or Hispanic Veterans, and those not currently married. Patients in VA hospitals also were more likely to have a service-connected disability, and to live in urban areas and closer to a VA hospital than patients with a non-VA hospitalization.


  • Findings suggest Veterans could experience worse outcomes for some types of care without well-developed community care networks based on quality standards and sufficient care coordination between VA and non-VA providers.


  • Study data precede the MISSION Act of 2018, so findings may not be generalizable to Veterans currently accessing non-VA care.
  • There may have been unobserved factors that influenced patient outcomes and hospital choice.

This study was funded by HSR&D. Drs. Yoon and Phibbs are part of HSR&D’s Health Economics Resource Center (HERC); Dr. Ong is part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP).

Yoon J, Phibbs C, Ong M, et al. Outcomes of Veterans Treated in Veterans Affairs Hospitals vs Non-Veterans Affairs Hospitals. JAMA Network Open. December 1, 2023; 6(12):e2345898.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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