Veterans Administration and ambulatory care: the "low-priority" veteran

We describe several consequences of an effort to reduce patient volume in a general medical clinic (GMC) by releasing "low-priority" veterans. With a before-after descriptive study, we determined what sources of medical care these veterans used and assessed changes in their medical status using hypertension as a tracer condition. Private providers were used exclusively by 35% of veterans, 33% continued to use VA medical services, 11% used a combination of VA and private care, and 16% used other miscellaneous sources of care. While most veterans (74%) paid cash for their care, 35% also used Medicare or Medicaid supplementally. In veterans with hypertension, the diastolic blood pressure distributions were ostensibly unchanged after release. These results suggest that a reduction in services provided to "low-priority" veterans is feasible without deleteriously affecting their medical status. With regard to blood pressure control, those veterans who obtained private sources of care did as well as those who remained in the GMC.