An Analysis of Potential Adjustments to the Veterans Equitable Resource Allocation (VERA) System

The Veterans Health Administration asked RAND's National Defense Research Institute to undertake a quantitative analysis of the Veterans Equitable Resource Allocation System (VERA). VERA was instituted in 1997 and was designed to improve the allocation of the congressionally appropriated medical care budget to the 22 regional service networks that composed the Veterans Administration (VA) health system. The modeling approach used in this analysis provides a tool that VA policymakers can use for making resource allocation decisions. This tool can also be used for a wide range of simulations as well as for facility-level allocations. The study concludes that the current VERA system for allocating resources to Veterans Integrated Service Networks (VISNs) does not reflect a number of measurable factors that affect patient care costs, including patient and facility characteristics that vary systematically across VISNs and that are largely beyond VISN directors' control. Alternative methods for allocating resources to VISNs, based on the principles that guide VERA but that better reflect these factors, may produce a more equitable allocation system.