HOW THE INSTITUTIONAL STRUCTURE OF THE VETERANS AFFAIRS HEALTHCARE SYSTEM ALTERS CLINICAL APPROACHES TO TREATMENT

Abstract

This thesis examines the health system of the United States Department of Veterans Affairs in order to understand how its institutional structure affects physician’s clinical decisions regarding patients suffering from opioid use disorder. It provides a summary of the literature on the Veterans Affairs (VA) healthcare system to analyze how institutional structures of the VA such as the organization, financing, physician reimbursement models, and health-related research done by the VA shape the behaviors and decision-making of physicians. The question of how the VA’s institutional structure impacts individual clinical behaviors and decisions is both multi-faceted and poorly understood. This thesis offers suggestions for future research that integrate approaches focusing on determinants of health, cultural competence, and the institutional structures of the VA system in order to understand the factors that are shaping how treatment decisions are made in a clinical setting and their impact on veterans.