and activities related to tobacco control reside. The relevant structure includes VHA, which provides health care for veterans; the National Leadership Board (NLB, a senior advisory group); the Public Health Strategic Health Care Group (PHSHCG) in VA headquarters, which develops policies and programs related to several major public-health concerns, including tobacco; and the Veterans Integrated Service Networks (VISNs, the regional units that administer VA health facilities).
VHA is charged with providing medical and rehabilitation services to veterans, medical research, graduate medical education, and emergency management. The VHA mission has shifted since the 1990s from a focus on inpatient care toward outpatient care. The changing focus has been reflected in the growth of outpatient clinics in the VA medical centers (VAMCs) and community-based outpatient clinics (CBOCs) to serve veterans who do not live near VA medical centers. VHA continues to provide long-term care for veterans in VA nursing homes and state-owned and -operated veterans’ homes, and contract care in private nursing homes, home health services, and adult day care. VHA does not provide health-care services for dependents or survivors of veterans, with a few exceptions.
VHA is directed by the VA under secretary for health, who reports to the secretary for veterans affairs, a member of the Cabinet. Headquarters staff report to the principal deputy under secretary for health, as does the deputy under secretary for health for operations and management (see Figure 6-1).
The VA health-care system provides direct health care, including outpatient and inpatient services. Veterans who enroll in the VA health system are assigned to one of eight priority groups (see Chapter 2, Box 2-8, for a description of the priority groups) on the basis of whether they have service-connected disabilities and on the basis of their income. Veterans who have medical conditions related directly to military service, those with lower incomes, and those who are uninsured are given higher priority than those with higher incomes or non–service-connected disabilities. Reservists and National Guard members who are called to active duty by a federal executive order may qualify for VA health-care benefits. Returning service members, including reservists and National Guard members who served on active duty in a theater of combat operations (for example, Iraq and Afghanistan), have special eligibility for hospital care, medical services, and nursing-home care for 5 years after discharge from active duty.