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Best Care Anywhere: Why VA Health Care Is Better Than Yours
Draws on the examples of the Veterans Health Administration to present a model for socialized medicine in America, explaining how its system is setting standards for best practices and cost reduction that significantly outperform the private sector. Original. $25,000 ad/promo.
159 pages, Paperback
First published January 1, 2011
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Displaying 1 - 23 of 23 reviews
August 19, 2011
I initially read this book since I work for the VA and it was going to be part of a leadership book club. However, i feel that it was about so much more than just the VA and their service. It really seemed to be a forum for health care in general. I feel that this should really start the discussion of changes in the US healthcare system. It may not have all the answers, but can begin a stimulating dialogue.
March 24, 2013
A great institutional success story; Longman's focus on the VA's progress over the past couple of decades is better than the policy recommendations implied by the subtitle, though both are concise and probably the first reading I'd recommend to anyone curious about healthcare in the US.
(Note: I'm familiar with the VA as a contractor helping them implement new technology.)
A summary: the veteran's health system was sub-par until the mid-'90s, when new leadership made some bold changes. It may surprise you to learn that VA evidence-based practices and electronic medical records are among the best in the world. This is partly due to the ever-feuding commercial health industry, whose providers generally refuse to have their mistakes measured, and whose vendors lobby government to effectively bribe practitioners to adopt their half-baked products. If you never read anything more on the subject, remember this: healthcare is complex and not a normal market, so laissez-faire is not a reliable shortcut to good outcomes.
(Note: I'm familiar with the VA as a contractor helping them implement new technology.)
A summary: the veteran's health system was sub-par until the mid-'90s, when new leadership made some bold changes. It may surprise you to learn that VA evidence-based practices and electronic medical records are among the best in the world. This is partly due to the ever-feuding commercial health industry, whose providers generally refuse to have their mistakes measured, and whose vendors lobby government to effectively bribe practitioners to adopt their half-baked products. If you never read anything more on the subject, remember this: healthcare is complex and not a normal market, so laissez-faire is not a reliable shortcut to good outcomes.
August 8, 2009
It's interesting how Longman comes to the conclusion that VA is the best healthcare in America. Fortune magazine assigned him the task of finding out who had the best solutions to the healthcare crisis. They (and Longman) assumed this would be found in the private sector. They were looking for an article about a dynamic CEO type running the company of the future that would take the healthcare industry by storm. What Longman found instead was perhaps the most counter intuitive result possible---the VA on the cutting edge medicine!
Needless to say Fortune didn't want to publish that information and Longman published his article in small-circulation Washington Monthly instead. This book is an expansion of that article.
In a nutshell Longman found that the typical American patient experiences too many procedures (some of them actually harmful)and that no one seems to be in charge of the overall program--in two ways. Since patients move in and out of their system all the time, private care providers have no financial incentive to look at the long-term. And since payment is based on doing things, lots of things get done, regardless of their effectiveness.
The VA has been able to address these problems because it has a long-term relationship with patients, it has an integrated system, and compensation isn't based on fee for service.
Needless to say Fortune didn't want to publish that information and Longman published his article in small-circulation Washington Monthly instead. This book is an expansion of that article.
In a nutshell Longman found that the typical American patient experiences too many procedures (some of them actually harmful)and that no one seems to be in charge of the overall program--in two ways. Since patients move in and out of their system all the time, private care providers have no financial incentive to look at the long-term. And since payment is based on doing things, lots of things get done, regardless of their effectiveness.
The VA has been able to address these problems because it has a long-term relationship with patients, it has an integrated system, and compensation isn't based on fee for service.
March 15, 2011
A fascinating read, if a little one-sided. Longman does his best to provide evidence in support of the VA EMR system, and much of his story is convincing. I came away from the book agreeing with his premise in spirit, if not in letter. The scientist in me was left wanting a deeper story behind many of the statistics in the book--it's clear that some of them are weighted in favor of the argument (e.g.- medical errors are the third leading cause of mortality in America; I am inclined to believe a lot of data massaging was done to come up with that number, but without a more complete picture, I am left to wonder). Still, one cannot ignore the thrust of his argument: the healthcare industry is in need of some fundamental innovations, and although his solutions can be argued with, the need for his argument cannot.
September 10, 2010
Exciting history of the VA and the VistA EHR platform. Compelling proposal on how the VA's model of health care delivery can be extended.
June 5, 2011
Most informed observers are well aware of the shortcomings of US health care. Its reliance on private health insurance has produced the costliest health care in the industrialized world with meager results to show for it. The vast array of health insurers that finance most of the nation's health care have little interest in the long term health of patients who can and do switch insurers as often as they change employers, move, or switch insurance for a variety of reasons. Physicians themselves are no more incentivized to focus on low intensity preventive medicine like consultations or simple behavior modification as their financial well-being is improved by increasing the number of treatments they provide, not maximizing patient health. Thus we see an enthusiasm for adopting the latest medical technologies with often unproven marginal benefit for patients. These disincentives to reduce costs, improve improve quality and reduce medical errors have all played in a part in the US's failure to systematically adopt electronic health records. Just as preventive treatments may yield benefits decades in the future, electronic health records create their value over the long term which likely accrues to organizations other than original investors in EHR. There exists little incentive for insurers or providers to bear these upfront costs when their financial solvency may even be threatened by it.
What US health care needs then is a system (that resembles most other industrialized nations) where providers have a strong incentive to keep patients healthy over their lifetime, to provide treatments whose effectiveness is based on sound evidence, and avoid those that needlessly drive up costs and expose patients to health risks. Electronic health records are vital to these objectives not only to reduce administrative costs present in a fragmented system, to reduce the number of avoidable medical errors currently plaguing US health care, but also to aid in effectiveness research that determines which treatments work best for which patient groups. What is needed is a system that maximizes health while minimizing cost, yet the health care reform debate of 2009-10 highlighted how difficult it is to transform the current system of private health insurance to one resembling what I've just described.
Which is why it came as such a surprise that the US already has such a system serving millions of people. The Veterans Health Administration is the largest integrated health system in the world and provides tax-funded health care to millions of veterans of the US armed forced in hospitals and outpatient facilities across the country. Immortalized in films likeBorn on The 4th of July, the VHA came under national scrutiny for providing shamefully poor quality care to Vietnam veterans in the 1970's and 80's. Yet it was this notoriety that lead to many of the important reforms that made the VHA what it is today. In order to coordinate care for millions of patients across the country, doctors themselves began developing a system of electronic health records over 30 years ago using non-proprietary open source software that has since been shared with health systems around the world free of charge. Unlike proprietary electronic health record systems, the VHA's system was able to be constantly improved by countless doctors and programmers since its implementation. The VHA thus has a working electronic health record system while the private market struggles to perfect a system that doctors will adopt. The sharing of information that EHR has enabled has helped the VHA avoid untold medical errors while helping it coordinate often complex care regiments for its patients who suffer disproportionally from a large number of ailments compared to the average American patient.
The VHA also recognized early the increasing importance of chronic conditions in the health of its patients and dramatically shifted its organizational structure from one centered around hospitals offering acute care to a more devolved system that could better manage treatment of conditions like diabetes which has been linked to, among other things, veterans' exposure to Agent Orange. Since the VHA's patients are lifetime users of its health care system it has every incentive to keep them healthy now and for years to come. This has translated to an emphasis on primary care, prevention, and a preference for drugs with proven cost-effectiveness as well as an avoidance of drugs and treatment that deliver minimal health improvements given their costs. In a stark difference from Medicare, a payroll tax-funded system, the VHA leverages its substantial buying power to negotiate lower drug prices for its patients. In fact, many veterans join the VHA's system simply to obtain lower drug prices. Unlike traditional fee-for-service health care, providers in the the VHA has no interest in providing treatment simply to increasing its revenue as its doctors are paid on salary. They are forced to improve patient health as much as possible within a constrained budget.
The VHA is the antithesis of everything US health care has come to be (in)famous for, and one quickly realizes that it resembles the British NHS more than anything on American shores. The British NHS is funded from general tax revenues and achieved universal coverage decades ago and is the epitome of what fear mongers refer to as 'socialized medicine'. Americans are made to fear socialized medicine about as much as they should fear anything, so one wonders, what is the quality of care that delivers to its patients? On measures of patient satisfaction, adherence to clinical guidelines of best practices, and a on the vast majority of patient health measures, the VHA outperforms both Medicare and commercial insurers. It has achieved these successes through a reemphasis on primary care, internal performance monitoring, and the use of electronic health records all at a sustainable cost. In the past, opponents of government run health care held up the VHA has an example of everything that is wrong with government intrusion into health care. The past 15 years however are a testament to everything that can be achieved by a large nonprofit organization focused improving patient health at least cost. Best Care Anywhere does a remarkable job in telling the story of how this has been made possible.
What US health care needs then is a system (that resembles most other industrialized nations) where providers have a strong incentive to keep patients healthy over their lifetime, to provide treatments whose effectiveness is based on sound evidence, and avoid those that needlessly drive up costs and expose patients to health risks. Electronic health records are vital to these objectives not only to reduce administrative costs present in a fragmented system, to reduce the number of avoidable medical errors currently plaguing US health care, but also to aid in effectiveness research that determines which treatments work best for which patient groups. What is needed is a system that maximizes health while minimizing cost, yet the health care reform debate of 2009-10 highlighted how difficult it is to transform the current system of private health insurance to one resembling what I've just described.
Which is why it came as such a surprise that the US already has such a system serving millions of people. The Veterans Health Administration is the largest integrated health system in the world and provides tax-funded health care to millions of veterans of the US armed forced in hospitals and outpatient facilities across the country. Immortalized in films likeBorn on The 4th of July, the VHA came under national scrutiny for providing shamefully poor quality care to Vietnam veterans in the 1970's and 80's. Yet it was this notoriety that lead to many of the important reforms that made the VHA what it is today. In order to coordinate care for millions of patients across the country, doctors themselves began developing a system of electronic health records over 30 years ago using non-proprietary open source software that has since been shared with health systems around the world free of charge. Unlike proprietary electronic health record systems, the VHA's system was able to be constantly improved by countless doctors and programmers since its implementation. The VHA thus has a working electronic health record system while the private market struggles to perfect a system that doctors will adopt. The sharing of information that EHR has enabled has helped the VHA avoid untold medical errors while helping it coordinate often complex care regiments for its patients who suffer disproportionally from a large number of ailments compared to the average American patient.
The VHA also recognized early the increasing importance of chronic conditions in the health of its patients and dramatically shifted its organizational structure from one centered around hospitals offering acute care to a more devolved system that could better manage treatment of conditions like diabetes which has been linked to, among other things, veterans' exposure to Agent Orange. Since the VHA's patients are lifetime users of its health care system it has every incentive to keep them healthy now and for years to come. This has translated to an emphasis on primary care, prevention, and a preference for drugs with proven cost-effectiveness as well as an avoidance of drugs and treatment that deliver minimal health improvements given their costs. In a stark difference from Medicare, a payroll tax-funded system, the VHA leverages its substantial buying power to negotiate lower drug prices for its patients. In fact, many veterans join the VHA's system simply to obtain lower drug prices. Unlike traditional fee-for-service health care, providers in the the VHA has no interest in providing treatment simply to increasing its revenue as its doctors are paid on salary. They are forced to improve patient health as much as possible within a constrained budget.
The VHA is the antithesis of everything US health care has come to be (in)famous for, and one quickly realizes that it resembles the British NHS more than anything on American shores. The British NHS is funded from general tax revenues and achieved universal coverage decades ago and is the epitome of what fear mongers refer to as 'socialized medicine'. Americans are made to fear socialized medicine about as much as they should fear anything, so one wonders, what is the quality of care that delivers to its patients? On measures of patient satisfaction, adherence to clinical guidelines of best practices, and a on the vast majority of patient health measures, the VHA outperforms both Medicare and commercial insurers. It has achieved these successes through a reemphasis on primary care, internal performance monitoring, and the use of electronic health records all at a sustainable cost. In the past, opponents of government run health care held up the VHA has an example of everything that is wrong with government intrusion into health care. The past 15 years however are a testament to everything that can be achieved by a large nonprofit organization focused improving patient health at least cost. Best Care Anywhere does a remarkable job in telling the story of how this has been made possible.
June 23, 2018
If we want to see health care reform become a reality in our lifetime, studying the VA healthcare system is the place to begin. “Advance the mission of true health care reform by bringing us closer to establishing the principle that access to affordable quality health care is a right of citizenship.”
June 3, 2019
Veteran's health services are the best one can get, as long as you are not eligible. This is a fairy tale for those who never experienced it.
January 20, 2011
I learned a lot about the history of VA from this book. There are a lot of interesting facts--such as it was the employees at VA that developed VISTA, not some crappy government contractor who overcharges and doesn't get the job done. (Yes, I'm looking at you, EDS. Your FedTraveler sucks.) I didn't know that VA is required to report all medical errors for oversight purposes while the private sector does not. I also didn't realize that a lot of facilities and practitioners were atrophying in the 1990s as the majority of the veteran population aged out and didn't replenish itself.
Unfortunately, the author has a somewhat skewed and, in my opinion, incorrect view of veteran's benefits. He acts like all VBA does is dole out rights to healthcare, when the reality is most of what VBA is giving out is monetary benefits. It's true that many veterans rightfully deserve that money, but whether it is a positive thing for them is another matter. For another take on the VA disability system (an unpopular one, at that) check out David Dobbs' April 2009 Scientific American article about PTSD.
As a VA employee, I want to make the agency the best that it can be at maximizing veterans' potential and making them whole. The healthcare end of it, or VHA, does seem to do a very good job for the most part. Read the book to find out about the scandals. Longman doesn't sugarcoat it. But he does highlight how effective the VA system is at doing it's job, in spite of the seemingly insurmountable political, scientific, medical, and logistical difficulties it faces.
Unfortunately, the author has a somewhat skewed and, in my opinion, incorrect view of veteran's benefits. He acts like all VBA does is dole out rights to healthcare, when the reality is most of what VBA is giving out is monetary benefits. It's true that many veterans rightfully deserve that money, but whether it is a positive thing for them is another matter. For another take on the VA disability system (an unpopular one, at that) check out David Dobbs' April 2009 Scientific American article about PTSD.
As a VA employee, I want to make the agency the best that it can be at maximizing veterans' potential and making them whole. The healthcare end of it, or VHA, does seem to do a very good job for the most part. Read the book to find out about the scandals. Longman doesn't sugarcoat it. But he does highlight how effective the VA system is at doing it's job, in spite of the seemingly insurmountable political, scientific, medical, and logistical difficulties it faces.
October 28, 2009
Best Care Anywhere is a well-written, easy-to-read discussion of a serious problem that we face and one possible solution to that problem. Unlike many books on the subject, this one is short and written in an easily accessible style. The analysis and suggestions are pragmatic. All Longman cares about is results, not ideology. Best Care Anywhere is must reading for anyone who wants to understand the health care issues that face the country and wants some understanding of what can be done about it.
September 23, 2009
Read this while on rotation at the VA.
I have to say I was very impressed with the care provided at the SLC VA.
They have more incentive to keep people well and to keep medical costs down.
Chapter 8: When less is more was fascinating.
I would recommend this read to anyone interested in improving healthcare in our nation.
I have to say I was very impressed with the care provided at the SLC VA.
They have more incentive to keep people well and to keep medical costs down.
Chapter 8: When less is more was fascinating.
I would recommend this read to anyone interested in improving healthcare in our nation.
December 10, 2011
This is a book everyone needs to read before discussing health care. Longman lays out reasons why the VA stood above its competition and you can really grasp several reasons that make our healthcare less than optimal.
I can not recommend this book highly enough.
I can not recommend this book highly enough.
June 6, 2020
Outlines challenges the Americans face funding an extremely expensive health care system, with insurance costs that are spiraling out of control at a much higher rate than inflation. Argues that the private payment per procedure is flawed, in part due to a lack of incentive to focus on long term consequences. Fact is people move to different regions and their electronic health record may not well follow them from specialist to specialist. Promotes the benefits of primary care which allow holistic co-ordination of care rather than people seeking numerous specialist opinions.
Main focus of book is that Veterans Affairs (VA) health care is run much more effectively than Medicare. Book promotes their open source electronic health record (ehr) software VistA ( http://worldvista.org/AboutVistA). Reduced beuracratic billing requirements and more of a salary based workforce model are also beneficial. VistA was initially built for use in the Veterans hospital but is used widely (book suggests not widely enough). Book suggests VistA is more user friendly than commercially available ehrs and also avoids vendor lock in; a concept in which health care data is owned by private proprietors. VA are able to use their more complete data sets to follow up cohorts of patients for research. These are then more robust assessments than using fragmented datasets that are locked in by vendors.
Main focus of book is that Veterans Affairs (VA) health care is run much more effectively than Medicare. Book promotes their open source electronic health record (ehr) software VistA ( http://worldvista.org/AboutVistA). Reduced beuracratic billing requirements and more of a salary based workforce model are also beneficial. VistA was initially built for use in the Veterans hospital but is used widely (book suggests not widely enough). Book suggests VistA is more user friendly than commercially available ehrs and also avoids vendor lock in; a concept in which health care data is owned by private proprietors. VA are able to use their more complete data sets to follow up cohorts of patients for research. These are then more robust assessments than using fragmented datasets that are locked in by vendors.
January 11, 2023
This book does a great job of describing the pros of VA healthcare. Where I got confused is the description around why it would not work for everyone in the US and how to navigate it being a government ran system. I would have liked more narrative around how the government could make this available for all without all of the negative side effects. I would have also liked more comparisons and contrast drawn between universal healthcare systems in other countries.
August 29, 2022
Solid, though now outdated, argument for why the VA is an exemplar for healthcare quality. Fascinating to read this in 2022 after the growth of value based healthcare, ACOs and integrated systems. Humbling read for anyone in the health professions as a reminder of how far we have left to go.
June 1, 2023
I can see how this book was groundbreaking at the time of its initial publication but many of the arguments fall relatively flat now. It just seems dated though some arguments still hold water or at least are partially true because the medical system is not perfect in America, nor will it ever be.
November 22, 2013
As with T R Reid's book The Healing of America, I can only think that people who have strong opinions about health care such as "it can be consumer-driven" (i.e., competition can lower prices), are grossly uninformed about the facts of the recent history of health care in America.
(If you're making a little healthcare reading list for yourself, read Reid first, then this one.)
This book is a mind-blower, more for the detail than the big picture. The big picture is that there is just one healthcare system in the USA which is very large, much less costly, and delivers very good care: And that organization is the Veteran's Administration (VA). Longman thinks it is a blueprint for national healthcare, but I would hazard the guess that it is a political non-starter for at least ten years if not more.
There are three big reasons for the cost efficiency and quality of VA service: (1) the VA can take a lifetime view of its patients (patients in the VA stay in the VA); (2) because the VA has a lifelong relationship with its patients, they have incentives for investing in prevention, which lowers over-all cost; (3) they have systematic IT that actually works -- it's based on a open source system called VistA which was developed by a rogue group of software developers at the VA. Along the way he grants that organizations such as Mayo, the Cleveland Clinic, and Kaiser-Permanente have elements of the VA strategy, but for a variety of reasons, the scale and/or costs are different. [If there is a subtext here for problematic care, it is University-affiliated hospitals.] And it's not just that it's great software. It's the software is integrated into a health system -- everything is coordinated (see esp. pp. 48-51).
The following is not a spoiler because it is announced in the title: Longman advocates the VA model for all Americans: He imagines that it would take place by extending Medicare and requiring providers who want to work with Medicare to follow the VA model.
But the explosions in the book are along the way. Such as:
"Only about 50 percent of the seven years of increased life expectancy at birth since 1950 is attributable to medical" (p. xxxix). [Sorry, health care industry, but what have you done for me lately?]
"patients in institutions that spend the most per capita have worse health outcomes than those in institutions that spend the least per capita" (p. xli). [Why? Staph infections, etc.]
"With the exception of the VA, what do most health-care providers get paid to do? Provide health? Hardly. They get paid to provide treatments" (p. 73).
Why is American healthcare paid by employers? It came about during WW2, "when the federal government imposed wage and price controls, some companies started offering health insurance in lieu of wages" (p. 81). THEN the unions started to bargain for it.
"prevention usually adds to medical costs instead of reducing them" (p. 84). This is why we need to drive towards quality - cost reduction is always going to be problematic.
"for employers, with their limited scope of interest in their employees' long-term health, there is nothing approximating a strong business case for investing in quality medicine or prevention. . . . [T]hose who argue that pressure from employers will one day force health-care providers to compete--for value--are deluded. They cannot explain why employers have not long since done so" (pp. 85-86).
"Generally, the more prestigious the hospital you check into, and the more eminent and numerous the physicians who attend you, the more likely you are to receive low-quality, or even dangerous and unnecessary care" (p. 91). All of chapter 8 backs up this remarkable claim.
Highly recommended.
(If you're making a little healthcare reading list for yourself, read Reid first, then this one.)
This book is a mind-blower, more for the detail than the big picture. The big picture is that there is just one healthcare system in the USA which is very large, much less costly, and delivers very good care: And that organization is the Veteran's Administration (VA). Longman thinks it is a blueprint for national healthcare, but I would hazard the guess that it is a political non-starter for at least ten years if not more.
There are three big reasons for the cost efficiency and quality of VA service: (1) the VA can take a lifetime view of its patients (patients in the VA stay in the VA); (2) because the VA has a lifelong relationship with its patients, they have incentives for investing in prevention, which lowers over-all cost; (3) they have systematic IT that actually works -- it's based on a open source system called VistA which was developed by a rogue group of software developers at the VA. Along the way he grants that organizations such as Mayo, the Cleveland Clinic, and Kaiser-Permanente have elements of the VA strategy, but for a variety of reasons, the scale and/or costs are different. [If there is a subtext here for problematic care, it is University-affiliated hospitals.] And it's not just that it's great software. It's the software is integrated into a health system -- everything is coordinated (see esp. pp. 48-51).
The following is not a spoiler because it is announced in the title: Longman advocates the VA model for all Americans: He imagines that it would take place by extending Medicare and requiring providers who want to work with Medicare to follow the VA model.
But the explosions in the book are along the way. Such as:
"Only about 50 percent of the seven years of increased life expectancy at birth since 1950 is attributable to medical" (p. xxxix). [Sorry, health care industry, but what have you done for me lately?]
"patients in institutions that spend the most per capita have worse health outcomes than those in institutions that spend the least per capita" (p. xli). [Why? Staph infections, etc.]
"With the exception of the VA, what do most health-care providers get paid to do? Provide health? Hardly. They get paid to provide treatments" (p. 73).
Why is American healthcare paid by employers? It came about during WW2, "when the federal government imposed wage and price controls, some companies started offering health insurance in lieu of wages" (p. 81). THEN the unions started to bargain for it.
"prevention usually adds to medical costs instead of reducing them" (p. 84). This is why we need to drive towards quality - cost reduction is always going to be problematic.
"for employers, with their limited scope of interest in their employees' long-term health, there is nothing approximating a strong business case for investing in quality medicine or prevention. . . . [T]hose who argue that pressure from employers will one day force health-care providers to compete--for value--are deluded. They cannot explain why employers have not long since done so" (pp. 85-86).
"Generally, the more prestigious the hospital you check into, and the more eminent and numerous the physicians who attend you, the more likely you are to receive low-quality, or even dangerous and unnecessary care" (p. 91). All of chapter 8 backs up this remarkable claim.
Highly recommended.
November 8, 2013
This is a stealth book.
Really about why medical care can reduce your health and how the VA commits to Veterans' Health even though it is more expensive, and then does it in a very effective and inexpensive way.
i tried to find negative reviews of Longman because this book is such a love story with the VHA. None. Nada. huh?
Along the way we hear:
* why computer nerds were fired for having desktops and had sugar put in their BMWs and vistA rocks worldwide
* Why Medicare will sink our country unless we adopt several VHA systems
* Why George Bush the younger and Chuck Hagel are big fans of socialized VHA medicine
* The bravery of Ken Kizer to say-- "every medical error will be reported and we won't fire you for them." and how setting up a NASA/federal air investigation system for healthcare made a huge difference, despite a LOT of media panning.
* The collective wisdom of the VHA, the gloriousness of massive research tied to health care, the power of (as in the military) training training training training.
*Why mission matters
*and, quite upsetting, those of us not veterans don't have a real health case system to choose (though Kaiser Permanente and even my Harvard Vanguard have elements of a HC system, such as standardized research-based treatment protocols and medical care providers on salary only).
and the next steps for the VHA beyond 2011 3rd edition? radical "Patient Centered Care & Cultural Transformation".
http://www.youtube.com/watch?v=qm44rU...
shows PCC chief Tracey Gaudet-- there are better internal videos, this gives you a 20 minute glimpse of the future. Are we?, is the VHA? ready to start every visit with "what brings you here today, what dream?" rather than, "how are your illnesses, brother John?"
health and well-being model vs. illness model-- which would you prefer?
Really about why medical care can reduce your health and how the VA commits to Veterans' Health even though it is more expensive, and then does it in a very effective and inexpensive way.
i tried to find negative reviews of Longman because this book is such a love story with the VHA. None. Nada. huh?
Along the way we hear:
* why computer nerds were fired for having desktops and had sugar put in their BMWs and vistA rocks worldwide
* Why Medicare will sink our country unless we adopt several VHA systems
* Why George Bush the younger and Chuck Hagel are big fans of socialized VHA medicine
* The bravery of Ken Kizer to say-- "every medical error will be reported and we won't fire you for them." and how setting up a NASA/federal air investigation system for healthcare made a huge difference, despite a LOT of media panning.
* The collective wisdom of the VHA, the gloriousness of massive research tied to health care, the power of (as in the military) training training training training.
*Why mission matters
*and, quite upsetting, those of us not veterans don't have a real health case system to choose (though Kaiser Permanente and even my Harvard Vanguard have elements of a HC system, such as standardized research-based treatment protocols and medical care providers on salary only).
and the next steps for the VHA beyond 2011 3rd edition? radical "Patient Centered Care & Cultural Transformation".
http://www.youtube.com/watch?v=qm44rU...
shows PCC chief Tracey Gaudet-- there are better internal videos, this gives you a 20 minute glimpse of the future. Are we?, is the VHA? ready to start every visit with "what brings you here today, what dream?" rather than, "how are your illnesses, brother John?"
health and well-being model vs. illness model-- which would you prefer?
October 24, 2015
This is an important history of a fabled success story that is stlll not discussed and appreciated enough. In hindsight, after more studies, VistA software does not seem as miraculous and error-free as it was thought to be at the time this book was written. But it's still making great strides, having been rated the easiest-to-use electronic health record by a survey of doctors, and being adopted in many countries on different continents. I think the lessons of this book for how to make software and how to run a government agency to be modern and responsive are the most important reasons to read the book.
August 27, 2016
This book was an outstanding read; I would definately recommend it to anyone going into a career within VHA; or the private sector healthcare industry as well. I say this, because electronic medical records will eventually be the standard in the private sector, ensuring continuety of care for patients regardless of where they choose to recieve it.
March 9, 2015
For a general interest book, I thought it was very good. I really enjoyed the stories related to VHA reform and summaries of the theories behind the American health care system. That said, I don't believe that the author has made the case that the American health care system should be reformed as he recommends. As a law student, I thought that the legal foundation was a bit crude.
September 15, 2014
Compelling evidence for integrated primary care. The VA medical system is ahead of most of the country in providing comprehensive care even under budgetary constraints.
April 25, 2015
Solid historical perspective on thought leadership from the Department of Veterans Affairs with respect to healthcare and the use of information technology.
Displaying 1 - 23 of 23 reviews