“The resource change is tied to actuarial estimates of demand and case mix changes for all veteran priorities. Demand is adjusted for expected utilization changes anticipated for an aging veteran population and for services mandated by statute,” the VA report read.

“The utilization projections are based on private sector benchmarks adjusted to reflect the VA health care services package, veteran age, gender, morbidity, reliance on VA versus other health care providers and degree of health care management. The changing health care demands reflect veterans’ increasing reliance on pharmaceuticals; the advanced aging of many World War II and Korean veterans in greater need of health care; and the outcome of high veteran satisfaction with the health care delivery.”

The VA forecast $45.704 billion in 2013 health care services costs and $47.691 billion in 2014, the bulk of that going to “acute care” – inpatient acute hospital care, ambulatory care, and pharmacy services.

“Key areas VHA will focus on over the next one to three years include: collaborative health professions education and training programs for safety and quality to ensure the provision of optimal health care; the delivery of compassionate, patient-aligned care that anticipates patient needs and is seamless across environments and conditions; and workforce development through succession planning,” the department report states.

“VHA’s long-term strategy, over the next several years, will include a focus on evidence-based personalized health care through investigating the potential of genomic medicine to anticipate the health needs of veterans. VHA’s performance measurement system is the final component of the strategic planning framework. Thirty-seven performance measures serve as indicators of how and when our objectives will be accomplished. Nine of these measures are identified as ‘key measures’ while two of these measures support Agency Priority Goals. The performance measures cover the entire range of clinical, administrative and financial actions required to support VHA’s strategies.”

Not everything in the health care budget involves direct medical facilities, personnel, or treatment. Also crucial to meeting the needs of a growing veterans population is the VA infrastructure, especially information technology, according to the budget proposal, which calls the VA system “one of the largest consolidated IT organizations in the world.”

“As can be seen, the delivery of high quality medical care and benefits to an increasing population of veterans is highly dependent upon adequate IT funding and support. Without it, quality and accessibility of service, as well as veteran satisfaction, will be adversely impacted,” the VA report states. “IT is integral to medical care at the VA. Quality of care, patient safety, and cost effectiveness have all been improved through extensive and effective use of IT.

“Since FY 2010, VA Medical Care funding has risen 18 percent, while IT funding is proposed to rise by 5 percent in FY 2013. Given the strong linkage and importance of IT to medical care and benefits delivery, the investment in IT will need to keep pace with the VA’s medical and benefits programs; otherwise VA will run the risk of degradation of services.”

The department also has been putting more money into advanced medical research, including gene typing and DNA sequencing – which could lead to individual patient-specific drugs and treatments with better results and fewer side effects – although actual funding has fallen significantly short of budget requests. While there was a major increase from FY 11 to FY 12 – $13.741 million to $20.2 million – it fell far short of the VA’s budget request of $30 million for R&D; the FY 13 request for $22.186 million represented a more modest increase sought.

One of the most outspoken critics of both DoD and VA health care budgets is The Military Coalition (TMC), 34 organizations representing more than 5.5 million members of the uniformed services – active, Reserve, retired, survivors, veterans – and their families. Those include the Air Force Association, AMVETS (American Veterans), Association of Military Surgeons of the United States, Association of the U.S. Army, Association of the U.S. Navy, Marine Corps League, National Guard Association of the United States, Reserve Officers Association, Society of Medical Consultants to the Armed Forces, Veterans of Foreign Wars, and the Wounded Warrior Project, as well as groups representing veterans of the U.S. Coast Guard and Public Health Service.