kim 1 | - Student
Jul 27, 2011 | #1
VA Healthcare - Approaches and Education
The current Department of Veterans Affairs (VA) was initiated in mid 1930 after an Executive Oder 5398 issued by President Hoover, introduced an independent federal agency called Veterans Administration. This agency consolidated all veteran activities and programs within the country. In 1989, Veteran Administrations was transformed into a federal cabinet-level VA after the signing of an Act (P. L. 100-527) by then, the president Ronald Reagan in 1988. The VA's three branches and Board of Veteran Appeals (BVA) are mandated to carry out nationwide veteran activities. First, the Veterans Health Administration (VHA) branch is mandated to oversee the health of veterans through their respective healthcare programs. The Veteran Benefits Administration (VBA) branch is meant for compensation, vocational rehabilitation, pension, educational assistance, insurance and home loan guaranty. The National Cemetery Administration (NAC) branch manages 120 cemeteries across US and also in Puerto Rico. The BVA is a body that acts as a decision maker over the appeals regarding veteran benefit claims. The impact of the current economic recession is magnified by the number of veterans in seeking basic needs like housing, food, education and healthcare. Likewise in the VA, the effect of world recession has threatened its operations in healthcare and benefit provision to its members. This term paper analyses the methods and approaches used by VA in the provision of healthcare and education to its members.
Healthcare
VA has been instrumental in the provision of healthcare to the enrolled veterans. Through its branch VHA, VA undertakes healthcare programs like primary and special care, and provision of other social and medical related services to support its eligible members (Elmendorf 4). The VHA has numerous packages offered to veterans like; impatient services, outpatient care and emergency services; preventive care, drug prescription, immunization and health education; and counseling, hospice care and home health services. VA through integrated delivery system offers medical services to more than 150 medical centers and 900 outpatient clinics. Additionally, VHA offers other facilities like long term care and readjustment counseling. The number of veterans accessing medical facilities has been increasing due to additional injection of resources by the federal government though VA congress department. For instance, an approximate of 5.1 million (22 percent) veterans accessed VHA medical facilities in 2008- a service provision of $40 billion.To administer healthcare effectively, VA has prioritized veterans health needs into eight categories based on service connected disabilities and, related exposures, assets and income among other factors. The categorization based on the above factors began in 1999 after the implementation of provisions made by Veterans Health Care Act (1996) (Elmendorf 2). The intensity of disability and environment exposure played an important role in constituting these veteran groups. These groups include; group one-individuals with disabilities emanating from service (or Service Connected Disabilities [SCDs]) amounting to 50 percent or more while, group two is composed of veterans with SDCs rated at 30 to 40 percent. The third group is composed of veterans with 10 to 20 percent SDCs, former prisoners of war, awarded Purple Heart, or disabled through treatment or professional rehabilitation offered by VA.
The forth group consists of individuals declared as catastrophically disabled by VA; thus, receive aid (cash benefits) to support their daily activities (Elmendorf 2). The fifth group entails individuals without SDCs (approximately zero percent) and eligible for Medicaid- VA offers them pension benefits. The sixth group is made of world war and Mexican border war participants with disorders connected with biological agents, nuclear and chemical vulnerability. The seventh groups involve veterans without disabilities and their income is above VA threshold but below the geographical index constituted by department of housing and urban development (HUD) (Elmendorf 3). The last group (group eight) is made of veterans without/ and with non-compensable disabilities and have incomes above both geographical index (by HUD) and VA threshold.
To ensure a continuous improvement of health care VHA has initiated numerous studies based programs like Internal/External Clinical Peer Review Programs (IPRP/EPRP). EPRP compares patient care records with practical or evidence based performance of that patient (Elmendorf 3). National Surgical Quality Improvement Program (NSQIP) compares risk adjustments in the areas with different mortality and morbidity rates. The Inpatient Evaluation Centre (IPEC) is a program meant to improve acute care in hospitals. Besides, Quality Enhancement Research Initiative (QUERI) numerous programs are useful in implementing the research findings into clinical practice. Finally, Evidence based Synthesis Program (ESP) makes systematic reviews on released medical research related issues subject to their importance towards VHA's user.
Recent Bills and Laws
The increasing number of veteran especially from Iraq and Afghanistan together with diversified health needs, different bills have proposed some being passed, delayed or rejected. These bills are meant to provide the veterans with health facilities especially during the current recession period. For instance, several proposals (HR 1588.S.481) in 2005 to extend the period meant for veterans health eligibility from two to five years lost grounds as a result of opposition from administration. Panangala connotes that, the current period of two years after combat is more suitable for veterans in seeking their VA health care (20). Another bill, Vet Centre Enhancement Act (2005) was passed by both Veterans Affairs Committee and later passed by the senate in 2005; however, it is still waiting House action. The aim of this act was to extend the health services offered in the veteran health centers to the immediate family members. Some of the services that could have befallen on the family members could have been counseling the family members of the bereaved soldier who died in active duty.
Currently, VA is pushing several bills to improve and extend health care services to veterans in the rural areas. There are several bills pending in different stages including like the house subcommittee on health, the senate committee on veteran affairs, house military committee on personnel and Indian affairs state committee. The pending bill on Rural, Veterans Health Care Improvement Act of 2009 (SB 658), this bill requires VA to establish at least one center in rural areas (US Department of Veteran Affairs [US-VA] "legislation" para17). These centers will be designated to carry out health research, clinical activities and health education in those areas through developing incorporating professional models and training expertise. One of the recent passed bills is the Caregivers and Veterans Omnibus Health Services Act of 2010 (US-VA "legislation" para11). This bill encompasses a variety benefits; namely, caregiver support, rural health improvements, mental health care matters, women veterans health care and homeless veterans. The extensive caregiver program covers instruction, preparation, personal care training services and counseling among other services. Through the enactment of these bills and implementation of some laws, VA will be able to offer a larger number of veterans a desirable quality health.
VA Education
VA is statutorily mandated to offer education and training programs to its members (veterans). The education and training programs are meant to improve the wellbeing of veterans in different perspectives especially the quality of health care. For instance, in the financial year 1999, VHA managed to sponsor over 110,000 scholars within 47 healthcare programs in collaboration with over 1,200 higher learning institutions like universities and colleges. According to Ramsaroop, Ball and Beaulieu, an approximate of two thirds of all US physicians, have received part of their training through VA (81). Thus, the VHA's health care system has emerged as an integral part of advancing the US healthcare higher education. Additionally, education based research conducted by VHA has been instrumental in enhancing the healthcare of veterans. Over the decades, these research and study programs have offered significant results which have improved healthcare through a wide ray of diversity, ranging from simple studies like multi-institutional trials and basic science studies to the complex studies like clinical outcome projects and heath care delivery.
GI Bill
The GI Bill was a composition of programs meant to offer social benefits to World War II (WWII) Korean and Vietnam veterans (Mink and O'Connor 339). Contrary to direct, retrospective cash benefits (bonuses) the veterans used to receive after their service during American Revolution and the World War I (WWI), GI Bill offered them immediate an immediate assistance so that they can improve their economic status. GI Bill offered benefits like education and training opportunities in colleges and vocational learning institutions. In vocational schools, the veterans acquired job related education to prepare them to enter professional job market. The original GI bill, the Servants Readjustment Act 1944 was pioneered to ease veterans' assimilation into the society life; however, afraid of unemployment in the depression era veterans made protests until the US federal government agreed to offer them education. The Roosevelt administration offered veterans one year education and training opportunity (Mink and O'Connor 340). Later under the influence of American Legion, veterans managed to get four years of training and education.
The GI Bill opportunity on education and training emerged as one of the most sought benefit by veterans (Gambone 66). For instance, after the implementation of the GI Bill, 7.8 million (over 51 percent) veterans enrolled themselves into education and vocational training. Among the veterans, 28 percent pursued college and university programs, 45 percent attended vocational training in learning institutions lower than college levels while the rest took part in other lesser job related training like farming programs. The education and training beneficiaries could enter the learning institution of their choice so long as they were eligible based on the laid down procedures and standards. GI Bill gave veterans full scholarships; that is, veterans fees was covered in full up to $500 per annum, with monthly subsistence cash benefits of $75 for single, $105 with one dependent while $ 120 for more than one dependent.
Having survived the hard economic times during the great depression and war era, colleges and other learning institutions were filled with new unique students- veterans. By 1949, a half all American school and college undergraduate students were veterans (Mink and O'Connor 341). The GI provisions on education transformed the higher education from being a higher-status Protestants, native-born and white Americans to Jews, Catholics, low and middle class, immigrants, black Americans and Latinos. Thus, GI did not only facilitate the affordability of education but also offered the segregated communities in the society the opportunity to learn (Gambone 67). As a result, GI Bill produced numerous veteran professionals in different fields; for instance, 450,000- engineers, 91,000 scientists, 17,000 writers and editors, 67,000 doctors and 238,000 teachers (Mink and O'Connor 342). African American Veterans Across The Country Were The Most Beneficiaries Of These Education Programs.
Post-9/11 GI Bill
With increasing number of veterans especially from Afghanistan and Iraq and the looming global economic hardship due to the current recession, VA with the support of congressional legislation is continuously supporting the education of veterans. For instance, Post-9/11 Veterans Education Assistance Act of 2008 (called Post-9/11 GI Bill), the Congress made a provision that offered comprehensive education assistance to the veterans and their dependents up to postsecondary education (US Government Accountability Office [US-GAO] 1). After Post-9/11 GI bill implementation, in 2010 VA availed more than $5.7 billion to fund education of around 381 veterans and their dependents. The amount of money to be provided for education in the year 2011 for veterans and dependents is estimated to reach $8 billion- a target to finance over 71 percent of all expenses.
The post 9/11 GI Bill is different from the original GI bill. The GI Bill offered its eligible claimants the benefits in monthly bases while, the post 9/11 GI Bill initiates a complex system of payments channeled through schools (the school fees) and students (housel allowance plus other benefits) (US-GAO 6). The tuition and fee benefits have been diversified to cover all public schools and a fixed amount (of $17,500) meant for foreign and private schools. The payments made directly to the students have been improved. For instance, the amount paid for house allowance has been increased, however it varies with locality, each student has been allocated up to $1,000 per year to cover book and supplies. Up to $100 on monthly bases has allocated to tuition while $ 500 has been offered for rural reallocation. The education privileges though offered to all veterans, the kind benefit will depend on the length of once service. For instance an individual who served for 90 days will be entitled for 40 percent, while a 36 months in service will guarantee one a full sponsorship (US-GAO 6).
Montgomery GI Bills
There are two Montgomery bills; namely, Montgomery GI Bill on Active Duty (MGIB-AD) and Montgomery GI Bill on Selected Reserve (MGIB-SR) (US-VA "the Montgomery" para1). The active duty member will be forced to pay $100 in a period of one year so that he can be eligible for education benefits ones an individual serves the minimum obligatory period. On the other hand, the selected reserve bill requires an individual to participate in the selected field for over six years to be eligible for education benefits. The MGIB-AD offers education benefits to veterans for at most 36 months. The education benefits offered by MGIB-AD and MGIB-SR program include certificate and degree programs, apprenticeship/on the job training, flight training and correspondence courses. In addition, this bill offers refresher, remedial and deficiency courses but only under certain circumstances. These benefits arising from MGIB-AD are offered after 10 year release from active role in the force. On the other hand, MGIB-SR is offered to individuals, who have suffered in the selected forces like navy reserve, air force reserve, army reserve and marine reserve (US-VA "the Montgomery" para1).
Conclusion
Since its inception, VA has played an important role in revolutionizing both education system and health care especially to the veterans. The statutory obligatory of VA is to avail basic needs like health, education, shelter and insurance and finances. This term paper has explored the VA's education and health care benefits to the veterans. First, VA facilitates health care services through numerous packages; namely, outpatient and inpatient programs, prevention care, counseling, hospice care and home health care. Through prioritized grouping, VA has fairly managed to allocate the health care benefits to its eligible veterans. Through introduction and support of numerous health bills and laws like Caregivers and Veterans Omnibus Health Services Act of 2010, VH has managed to commence centers within rural areas so that they can carry out health education, health research and practice clinical services. Also, VA has been instrumental in revolutionizing education. VA offers education to veterans ranging from simple like farming studies to complex like professional programs like engineering, physician and teachers. To improve education VA has supported and proposed numerous bills like GI Bill, Post-9/11 GI Bill, Montgomery GI bills that were passed by Congress. The primary aim of these bills has been to improve the education status of veterans and its near dependents. Finally, with increasing number of veterans and dependents, VA continues to restructure its policies to improve service provisions to its members.
