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Tables of Contents for An Analysis of the Veterans Equitable Resource Allocation (Vera) System
Chapter/Section Title
Page #
Page Count
Preface
iii
Figures
ix
Tables
xi
Summary
xiii
Acknowledgments
xvii
Acronyms
xix
Introduction
1
8
Description of the VERA System
2
2
Understanding the Incentives Created by VERA
4
5
Data Sources and Methods
9
4
Document and Literature Reviews
9
1
VISN and Facility Interviews
10
3
The Impact of Selected Patient and VISN Characteristics on Care Under VERA
13
24
The Maintenance of Older-Than-Average Medical Facilities and Infrastructures
13
6
Funding for Maintenance Under VERA
14
1
The Impact of VERA on Maintenance
14
2
The Impact of Age and Historical Significance on Costs
16
3
Populations of Enrolled Veterans Who Are Older and More Disabled
19
5
The Case for Case-Mix Adjustments
19
1
How VERA Adjusts for Differences in Case Mix Across VISNs
20
1
The Effects of the Current Case-Mix Adjustment on the Delivery of Health Care
20
3
How Could the VERA Case-Mix Adjustment Be Refined?
23
1
Major Consolidation of Facilities and Services
24
4
The Effects of Consolidation
25
1
Costs Associated with Consolidations
26
1
Barriers to Consolidation
27
1
Backlogs and Waiting Periods for Appointments in Rural and Urban Settings
28
7
Beneficial Impacts of VERA on Access
29
1
Detrimental Impacts of VERA on Access
30
3
Differential Costs of Health Care Delivery in Urban and Rural Settings
33
1
Should the VERA Methodology Adjust for the Rural/Urban Nature of VISNs?
34
1
Summary of Findings
35
2
The Costs of Academic Affiliations Under Vera
37
18
Overview of DVA Academic Affiliations
37
1
What Are the Costs and Other Requirements for Maintaining Academic Affiliations?
38
9
Requirements for Maintaining Academic Affiliations
39
1
Benefits of Academic Affiliations
40
1
Costs of Maintaining Academic Affiliations
41
5
Medicare Support for Costs Associated with Academic Affiliations
46
1
Does VERA Account for Costs of Maintaining Academic Affiliations?
47
3
Costs Funded Outside VERA
47
1
Support Costs Funded Through VERA
48
2
Recognition of Differences in Other Patient Care Costs
50
1
What Is the Role of State-of-the-Art Equipment in Maintaining Academic Affiliations and the Related Costs?
50
2
Accreditation Requirements for Equipment
50
1
VERA Funding for Equipment Costs ($605 million in FY 2001)
51
1
Summary of Findings
52
3
Vera and Weather-Related Costs
55
8
Considerations
55
1
VERA's Accountability for Weather-Related Cost Differences
56
1
Adjusting the Current VERA Methodology to Account for Weather-Related Costs
57
3
Differences in Building and Maintenance Costs
57
2
Access to Care
59
1
Influence of Weather on Case Mix
59
1
Summary of Findings
60
3
Analysis Plan For Evaluating Potential Vera Modifications
63
10
Units of Analysis
64
1
Data Requirements
64
2
Proposed Analyses
66
7
Conceptual Overview
66
1
Technical Overview
67
5
Simulating the Effects of Modifications to VERA
72
1
Conclusions
73
20
Appendix
A. Key Formulas and Data in the FY 2001 Vera
77
6
B. Guide for Rand Vera Site Visits-Networks
83
4
C. Guide for Rand Vera Site Visits-Facilities
87
4
D. Vera Eligibility Categories and Priority Groups
91
2
References
93
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