The cure for what ails the VA

The cure for what ails the VA:

If you have a sclerotic hospital system on which everyone else has given up, the solution is Dr. Ramanathan Raju, currently the head of the public hospital system in New York but previously chief executive of the Cook County Health and Hospitals System.  No one in Chicago public life gets an A-plus from everyone, but doctors, politicians and journalists alike agree that Dr. Raju took a failing system and turned it around: re-imagining its role in a changed health care landscape while dealing with its day-to-day personnel and quality issues. The improvement has been dramatic and rapid: though Dr. Raju was only in place for two years (much to our dismay), the improvement in the Cook County public health system is obvious to all.

Hire Dr. Raju to fix the V.A.  He’s never met a bureaucracy he couldn’t tame.

(I don’t know him personally and certainly have not solicited his permission to recommend him.  In fact, he was eager to return to his family in New York, which would probably not welcome his leaving again for Washington-but, when duty calls . . . )

Improving the Quality of Addiction Treatment

To bring market forces to bear on health care improvement, one needs service consumers who (a) Can detect quality (b) Are aware of what they are paying and (c) Have choices between providers. These three things are rarely true of the people who receive services from public sector addiction treatment programmes.

One way to handle this problem is to create an artificial market within a public health care system, i.e., have experts measure quality of care and then pay a bonus to treatment providers who offer the highest quality services. The Veterans Health Administration has done this for years, with impressive effects. But, in a paper kindly flagged by Austin Frakt today, my colleagues and I found that this approach has been less successful at improving the outcomes of addiction treatment.