“Availability of healthcare providers for rural veterans eligible for purchased care under the veterans choice act”

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.

Experiences with the Veterans’ Choice Program

“…Similarly, Ohl and colleagues found that VA played a greater role in providing healthcare for Veterans in counties over 40 miles from VA healthcare facilities compared with Veterans in counties within 20 miles of VA facilities. 24 Veterans' health status influenced the extent of VCP interest in that sicker individuals (i.e., higher HCC health risk scores) had higher odds of interest in VCP. This finding may be attributable to the added burden of travel or cumulative wait times experienced by Veterans needing more frequent visits.…”

Differences in Receipt of Alcohol‐Related Care Across Rurality Among VA Patients Living With HIV With Unhealthy Alcohol Use

“…However, this is unlikely to have impacted our results because disparities in rural areas have also been documented outside of the VA, showing lower access to non-VA specialty care. 59 In combination with very low rates of AUD medication receipt, findings from this study are concerning regarding access to evidence-based treatment for AUD among the population of PLWH living in more rural areas. While specialty addictions treatment is available in VA, it may be difficult to access care in rural areas, 56 and many patients prefer not to engage in specialty care.…”

“…We note that some patients may have accessed care outside of VA, which would not have been measured in these data. However, this is unlikely to have impacted our results because disparities in rural areas have also been documented outside of the VA, showing lower access to non‐VA specialty care …”

“…Thus, increased partnerships with community‐based non‐VA care may help address under‐receipt of specialty addictions treatment for PLWH living in rural areas. However, again, the availability of non‐VA community‐based specialty addictions treatment for AUD in rural areas is unclear . In addition, AUD medications have been shown to be as effective as specialty addictions treatment when prescribed along with ongoing medical management, and thus may be a viable option for provision in primary care settings.…”

“…However, again, the availability of non-VA communitybased specialty addictions treatment for AUD in rural areas is unclear. 59 In addition, AUD medications have been shown to be as effective as specialty addictions treatment when prescribed along with ongoing medical management, [67][68][69] and thus may be a viable option for provision in primary care settings.…”