The Veterans Affairs (VA) system was lauded for achieving system-wide improvements in the quality of care during the 1990s and 2000s. More recently it has drawn criticism for poor access to care at some facilities, exacerbated in part by gaming data to achieve quality targets. This systematic review found that VA hospitals provide equally safe care compared to non-VA hospitals across most medical and surgical hospitalizations, and generally (but not always) provided more effective care. The performance and recent challenges faced by the VA system were discussed in a 2014 editorial.