THE VETERANS HEALTH-CARE SYSTEM - PREPARING FOR THE 21ST-CENTURY

Since its establishment in 1946, the veterans healthcare system has gr eatly expanded in both size and responsibility. It is now the largest integrated healthcare system in the United States, the nation's larges t provider of graduate medical and other health professional training, and one of the largest research enterprises in America. It is also th e nation's largest provider of services to homeless persons, an essent ial provider in the public healthcare safety net, and an increasingly important element in the federal response to disasters and national em ergencies. Patterned after what was considered the best in American he althcare, for most of the past 50 years the Department of Veterans Aff airs (VA) healthcare has focused primarily on acute inpatient care, hi gh technology, and medical specialization. Now, in response to societa l and industrywide forces, the Veterans Health Administration (VHA) is reengineering the veterans healthcare system, changing the operationa l and management structure from individual hospitals to 22 integrated service networks and transitioning the system to one that is grounded in ambulatory and primary care. This article briefly describes the his tory and functions of the veterans healthcare system, its service popu lation, and key aspects of its restructuring.