The cost of VA-sponsored research

Background. Under pressures to reduce health care costs, clinical income is a shrinking source of support for research. Such pressures also threaten research at the medical centers of the Department of Veterans Affairs (VA). VA research is particularly vulnerable because medical care appropriations constitute a large, though unknown, source of support. This study measures the medical care component and the total of VA research funds. Method. The incremental costs of VA research were estimated from a survey of 497 clinician investigators and data on payroll, facility costs, and research grants and appropriations. Results. The incremental costs of VA research totaled $541.4 million in the 1992-93 fiscal year. This included $245.6 million in federal appropriations for VA research, $33.1 million in research grants administered by the VA, and $262.8 million in support from other VA appropriations. Research added as much as $219.8 million to VA patient care costs. Conclusion. The VA is adopting strategies to increase the internal payoff of its research. The fiscal constraints facing VA and other academic medical centers mean that they will be able to support research with their own funds only when it benefits them directly.