limited degree of sharing despite many opportunities to improve health care for beneficiaries while saving taxpayer dollars through “eliminating or consolidating underused or duplicative facilities, equipment, and staff,” reducing the reliance on purchased care, and “increasing staff proficiency and improving patient care by consolidating workloads and resources” (GAO, 1978, p. 28).
The 1978 GAO report contained a number of specific recommendations for the departments, the Office of Management and Budget, and Congress, including a draft bill. In response, Congress enacted the Veterans Administration and Department of Defense Health Resources Sharing and Emergency Operations Act of 1982 (Public Law 97-174) to remove obstacles to greater sharing of health care resources between the VA and the DoD and to give military treatment facilities (MTFs) and VA medical centers (VAMCs) greater incentives to share resources. Public Law 97-174 remains the chief legislative basis for partnering between DoD’s Military Health System and the Veterans Health Administration (VHA).
National Defense Authorization Act of Fiscal Year 2003
In 2002, Congress mandated initiatives intended to spur additional VA/DoD health care collaborations in the fiscal year (FY) 2003 National Defense Authorization Act (NDAA 2003).
DoD/VA Demonstration Projects
The NDAA 2003 directed the DoD and the VA to fund health care coordination demonstration projects between the two organizations’ health care facilities. Seven demonstrations were implemented in 2005, “designed to improve the coordination of health care resources between VA and DoD for application elsewhere” (VA/DoD, 2006, p. 19) in the areas of budget and financial management,2 coordinated staffing and assignment,3 and medical information and information technology (IT)4 (Navy Medicine, 2012).
2 The sites for the budget and financial management demonstrations were the VA Pacific Islands Health Care System/Tripler Army Medical Center and the Alaska VA Health Care System/3rd Medical Group at Elmendorf Air Force Base (Navy Medicine, 2012).
3 The coordinated staffing and assignment demonstrations were the Augusta VA Health Care System/Eisenhower Army Medical Center and the Hampton VA Medical Center/1st Medical Group at Langley Air Force Base (Navy Medicine, 2012).
4 The medical information and information technology demonstrations were the Puget Sound VA Health Care System/Madigan Army Medical Center, the El Paso VA Health Care System/William Beaumont Army Medical Center, and the South Texas VA Health Care System/Wilford Hall Air Force Medical Center/Brooke Army Medical Center (Navy Medicine, 2012).