The Public Interest

At the VA, it pays to be sick

Douglas Mossman

Winter 1994

SHOULD WE encourage veterans with psychiatric problems to remain ill? Should we encourage them to undergo unnecessary hospitalization? And, for those already hospitalized, should we encourage longer hospital stays than necessary? Surely most people—experts and nonexperts alike—would say no. Yet the Department of Veterans Affairs (VA) provides exactly these sorts of incentives to our nation’s veterans. Sadly, a program with good intentions has yielded a series of perverse incentives that reward illness, encourage patients to view themselves as incapacitated, and poison the relationships between patients and their caregivers.

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