Extreme makeover: Transformation of the veterans health care system

Annu Rev Public Health. 2009:30:313-39. doi: 10.1146/annurev.publhealth.29.020907.090940.


The veterans health care system administered by the U.S. Department of Veterans Affairs (VA) was established after World War I to provide health care for veterans who suffered from conditions related to their military service. It has grown to be the nation's largest integrated health care system. As the system grew, a number of factors contributed to its becoming increasingly dysfunctional. By the mid-1990s, VA health care was widely criticized for providing fragmented and disjointed care of unpredictable and irregular quality, which was expensive, difficult to access, and insensitive to individual needs. Between 1995 and 1999, the VA health care system was reengineered, focusing especially on management accountability, care coordination, quality improvement, resource allocation, and information management. Numerous systemic changes were implemented, producing dramatically improved quality, service, and operational efficiency. VA health care is now considered among the best in America, and the VA transformation is viewed as a model for health care reform.

Publication types

  • Review

MeSH terms

  • Decision Making, Organizational
  • Delivery of Health Care / organization & administration*
  • Disabled Persons
  • Health Care Reform*
  • Hospitals, Veterans / standards
  • Humans
  • Military Medicine / organization & administration*
  • Organizational Culture
  • Primary Health Care
  • Quality of Health Care
  • United States
  • United States Department of Veterans Affairs / organization & administration*
  • United States Department of Veterans Affairs / trends