"Availability of healthcare providers for rural veterans eligible for purchased care under the veterans choice act".

Autor: Ohl ME; VA Office of Rural Health (ORH), Veterans Rural Health Resource Center- Iowa City, Iowa City VA Medical Center, Iowa City, IA, USA. Michael-ohl@uiowa.edu.; Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Mailstop 152, Iowa City VAMC, 52246m, Iowa City, IA, USA. Michael-ohl@uiowa.edu.; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. Michael-ohl@uiowa.edu., Carrell M; Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, IA, USA., Thurman A; Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Mailstop 152, Iowa City VAMC, 52246m, Iowa City, IA, USA., Weg MV; Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Mailstop 152, Iowa City VAMC, 52246m, Iowa City, IA, USA.; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA., Hudson T; Center for Mental Healthcare and Outcomes Research, Central Arkansas VA, Little Rock, AR, USA., Mengeling M; Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Mailstop 152, Iowa City VAMC, 52246m, Iowa City, IA, USA., Vaughan-Sarrazin M; Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Mailstop 152, Iowa City VAMC, 52246m, Iowa City, IA, USA.; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2018 May 29; Vol. 18 (1), pp. 315. Date of Electronic Publication: 2018 May 29.
DOI: 10.1186/s12913-018-3108-8
Abstrakt: Background: 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. 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.
Methods: We combined 2013 administrative data on VHA-users with county-level data on rurality, non-VHA provider availability, population, household income, and population health status.
Results: Most (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).
Conclusions: Initiatives 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.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje