Abstract
BackgroundMilitary Veterans in the United States are more likely than the general population to live in rural areas, and often have limited geographic access to Veterans Health Administration (VHA) facilities. In an effort to improve access for Veterans living far from VHA facilities, the recently-enacted Veterans Choice Act directed VHA to purchase care from non-VHA providers for Veterans who live more than 40 miles from the nearest VHA facility. To explore potential impacts of these reforms on Veterans and healthcare providers, we identified VHA-users who were eligible for purchased care based on distance to VHA facilities, and quantified the availability of various types of non-VHA healthcare providers in counties where these Veterans lived.MethodsWe combined 2013 administrative data on VHA-users with county-level data on rurality, non-VHA provider availability, population, household income, and population health status.ResultsMost (77.9%) of the 416,338 VHA-users who were eligible for purchased care based on distance lived in rural counties. Approximately 16% of these Veterans lived in primary care shortage areas, while the majority (70.2%) lived in mental health care shortage areas. Most lived in counties that lacked specialized health care providers (e.g. cardiologists, pulmonologists, and neurologists). Counterintuitively, VHA played a greater role in delivering healthcare for the overall adult population in counties that were farther from VHA facilities (30.7 VHA-users / 1000 adults in counties over 40 miles from VHA facilities, vs. 22.4 VHA-users / 1000 adults in counties within 20 miles of VHA facilities, p < 0.01).ConclusionsInitiatives to purchase care for Veterans living more than 40 miles from VHA facilities may not significantly improve their access to care, as these areas are underserved by non-VHA providers. Non-VHA providers in the predominantly rural areas more than 40 miles from VHA facilities may be asked to assume care for relatively large numbers of Veterans, because VHA has recently cared for a greater proportion of the population in these areas, and these Veterans are now eligible for purchased care.
Highlights
Military Veterans in the United States are more likely than the general population to live in rural areas, and often have limited geographic access to Veterans Health Administration (VHA) facilities
To better understand potential challenges associated with purchasing of care for rural Veterans under the Choice Act, we identified VHA-users who were eligible for purchased care based on distance to VHA facilities, and quantified the availability of various types of non-VHA providers in counties where these Veterans lived
VHA-users who were eligible for purchased care based on distance were much more likely than the overall United States (US) population to live in counties that were any category of rural (87.9% vs. 17.1%), ruralremote (20.5% vs. 2.2%), median household income < $40,000 per year (40.4% vs. 10.7%), very poor population health status (28.4% vs. 10.3%), primary care shortage areas (15.8% vs. 4.2%), and mental health care shortage areas (70.2% vs. 22.0%)
Summary
Military Veterans in the United States are more likely than the general population to live in rural areas, and often have limited geographic access to Veterans Health Administration (VHA) facilities. Following a series of highly-publicized events surrounding problems with access to care, Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 (aka the “Choice Act”) [5]. This act directed VHA to offer to purchase care from non-VHA providers for Veterans who live more than a 40-mile drive from the nearest VHA care site, or who are unable to obtain needed care in VHA within a “reasonable period” (i.e. generally within 30 days). Eligibility for purchased care by the 40-mile criterion is relevant to Veterans living in rural areas of the US
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