Medical Care — Is More Always Better?

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Abstract
During the past decade, the Department of Veterans Affairs (VA) undertook a major reform of its health care system, one that is increasingly relevant as the United States confronts rapidly rising health care spending and persistent gaps in the quality of care. While the rest of the country moved toward less tightly structured delivery systems and unfettered access to specialists, the VA reform established 22 regional, integrated service-delivery networks, closed a substantial fraction of its hospital beds, and focused on ensuring access to high-quality primary care.1 According to the VA Central Office, between 1994 and 1998 the number of veterans . . .