The VA's Systems of Care and the Veterans under Care

The VHA must be a comprehensive, integrated healthcare system that provides excellence in healthcare, excellence in service to veterans, and excellence in medical education and research. The Department of Veterans Affairs (VA) is composed of three operating units: the Veterans Health Administration (VHA), Veterans Benefits Administration, and the National Cemetery Administration. The mission of the VHA is to serve the healthcare needs of America's veterans by providing primary care, specialized care, and related medical and social support services. To accomplish this mission, the VHA must be a comprehensive, integrated healthcare system that provides excellence in healthcare, excellence in service to veterans, and excellence in medical education and research. The VHA has four statutory responsibilities, which include patient care, medical education, research, and contingency support. The VHA's primary responsibility is to provide quality healthcare services to veterans and to reduce their burden from illness, injury, and disability, especially for those conditions that are related to their military service. Likewise, the VHA provides comprehensive education and training programs that enhance the quality of care provided to veterans. The VA manages the largest medical education and health professions training program in the United States. The VA facilities are affiliated with 107 medical schools, fifty-five dental schools, and more than 1,200 other health professions schools across the country. Each year, about 90,000 health professionals are trained in VA medical centers. More than half of practicing physicians had some of their professional education in the VA healthcare system. The VA's research focuses on areas of concern to veterans. It includes basic biomedical research, clinical trials and epidemiology, health services research, and rehabilitation research. The VA's research has earned an international reputation for excellence in such areas as aging, chronic disease, prosthetics, and mental health. Studies conducted within the VA system improve medical care not only for veterans, but for the nation at large. Because seven in ten VA researchers are also clinicians, the VA is uniquely positioned to translate research results into improved patient care. Special VA Centers of Excellence conduct leading-edge research in areas of prime importance to veterans such as neurotrauma, prosthetics, spinal cord injury, hearing and vision loss, alcoholism, stroke, aging, and healthcare disparities. Researchers at multiple VA sites collaborate to conduct large clinical trials to investigate the best therapy for diseases affecting large numbers of veterans. The VHA is the primary contingency backup for the Department of Defense's medical care system and currently is treating substantial numbers of active duty personnel injured in Iraq and Afghanistan. The VHA also provides emergency support for the U.S. Public Health Service and the National Disaster Medical System in times of natural and other disasters. For example, the VA sent several hundred clinicians and administrative personnel to Louisiana to assist in the disaster that followed Hurricane Katrina. Systems of Care The VA was first established as the Veterans Administration in 1930. From fifty-four hospitals in 1930, the healthcare system has grown to more than 1,400 sites of care as of the end of fiscal year (FY) 2008, including 153 medical centers, 919 ambulatory care and communitybased outpatient clinics, 135 nursing homes, forty-seven domiciliary residential rehabilitation treatment programs, 230 veterans centers and 137 comprehensive homecare programs (Department of Veterans Affairs, 2008). There are VA facilities in every state, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, American Samoa, Guam, and the Philippines. The VA's healthcare facilities provide a broad spectrum of medical, surgical, and mental health services as well as extended and rehabilitative care. …