In 1996, responding to a congressional mandate, the U.S. Navy studied the possibility of establishing a VA inpatient facility within the U.S. Naval Hospital on Guam to serve the health care needs of veterans. Naval Hospital. Guam and CNMI Veterans’ Health Care Needs Met Through VA’s Network of Providers

Veterans residing on Guam and CNMI receive VA health care through a network of providers, including outpatient care provided through the VA clinic, inpatient and specialty care provided at the U.S. For Cardiac Care and Other Services Not Available on Guam, Aeromedical Evacuations Are Used

When veterans require health care that is not available on Guam, VA will send them (as DOD does for its military beneficiaries) via a military or commercial aircraft to a VA, military, or private hospital in Hawaii or the continental United States. According to VA and DOD records, in fiscal years 1995 through 1997, a total of 1,140 medical evacuations were provided—1,071 for military beneficiaries and 69 for veterans. VA Can Likely Meet Future Demand for Health Care to Veterans on Guam and CNMI

While representatives of veterans organizations on Guam expressed concern about the future availability of health care on Guam, DOD and VA officials believe that VA’s network for providing outpatient care, inpatient care, and medical evacuations will continue into the future even if there is an increase in demand for these services. Naval Hospital. Under this scenario, we estimate that by the year 2010, these veterans could potentially need 1.01 inpatient beds per day, on average, up from the 1997 utilization of about 0.5 beds per day, on average. Naval Hospital

With a current capacity of 146 beds—consisting of 29 active and 117 inactive beds—U.S. Naval Hospital officials told us that the hospital could handle even the highest potential veteran inpatient need, projected under the high-demand scenario of up to 14 inpatient beds by the year 2010. Naval Hospital officials are confident that—using VA reimbursements for veteran inpatient care—they could activate beds and hire additional staff to care for these veterans, if needed. Apart from a large conflict or war, which they could not predict, Navy officials felt confident that they had or could obtain sufficient resources to handle any likely increase in veteran inpatient workload. Also, in the unlikely event that Guam and CNMI veteran demand for services increased significantly, U.S. Navy officials believe that the U.S. Naval Hospital will be able to meet even the highest projected workload. While veterans consider evacuations inconvenient and would like the U.S. Naval Hospital on Guam would not be able to offer cardiac surgery and ensure quality of care. Scope and Methodology

We were asked to (1) describe how VA currently meets Guam and CNMI veterans’ health care needs, (2) estimate these veterans’ possible future demand for health care and assessed VA’s ability to meet this demand, and (3) estimate the cost to establish a veterans’ inpatient ward at the U.S. Naval Hospital on Guam.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the need for establishing a Department of Veterans Affairs (VA) inpatient facility on Guam, focusing on: (1) how VA currently meets Guam and the Commonwealth of the Northern Mariana Islands (CNMI) veterans' health care needs; (2) veterans' possible future demand for health care and VA's ability to meet this demand; and (3) the cost to establish a veterans' inpatient ward at the U.S. Naval Hospital on Guam.

What GAO Found

GAO noted that: (1) to meet the health care needs of veterans on Guam and CNMI, VA currently provides services through a network of providers; (2) this network includes outpatient and inpatient care provided on Guam as well as by military or private hospitals in Hawaii or the continental United States, which is accessed through aeromedical evacuations; (3) in discussing their concerns about the VA health care system, veterans on Guam told GAO that medical evacuations, while necessary, are inconvenient and that they would like the U.S. Naval Hospital on Guam to provide cardiac care to reduce the need for some of these evacuations; (4) however, VA and Naval Hospital records indicate that only 15 percent of the 1,140 medical evacuations provided to military beneficiaries and veterans over the past 3 years were for cardiac care, which, according to Department of Defense officials, is an insufficient workload to maintain quality care for this specialty; (5) in the future, VA and Navy officials expect to be able to continue to meet veterans' demand for health care; (6) VA and Navy officials told GAO that they expect to continue providing the same type of health care to Guam and CNMI veterans that is currently available, including the services provided by the U.S. Naval Hospital; (7) even if there were a significant increase in veterans' demand for inpatient medical care in the future, U.S. Naval Hospital officials believe that their hospital could handle the potential veteran inpatient workload; (8) currently, the U.S. Naval Hospital has a total capacity of 146 beds--consisting of 29 active beds and 117 inactive beds; (9) in fiscal year 1997, of the 29 active beds, military beneficiaries used 22 beds per day on average and veterans used less than 1 on average; (10) GAO's analyses indicate that, under a high-demand scenario, Guam and CNMI veterans would use, on average, 14 inpatient beds per day; (11) while it is highly unlikely that Guam and CNMI veterans' demand for inpatient health care will ever reach this level, Navy officials told GAO that the U.S. Naval Hospital could hire staff and activate additional beds, if needed, to meet this demand; (12) these officials said that apart from a large conflict or war, which they could not predict, they were confident that the U.S. Naval Hospital on Guam could handle any likely increase in veteran inpatient workload; and (13) in light of GAO's analysis, establishing an inpatient ward at the U.S. Naval Hospital is not warranted and would be expensive.