Go backSearch Session number: 1085

Abstract title: VA Enrollees' Access to VA and Non-VA Hospitals and its Impacts

Author(s):
A Jayadev - Center for Health Quality Outcomes and Economic Research
Y Shen - Center for Health Quality Outcomes and Economic Research AND Boston University School of Public Health
J Gardner - Center for Health Quality Outcomes and Economic Research

Objectives: Most VA enrollees also seek care from non-VA hospitals. This study examines enrollees’ geographic access to VA/non- VA hospitals and its impact on VA utilization.

Methods: We merged “1999 enrollee survey data” (zipcodes, insurance coverage, use of VA/non-VA care and personal characteristics) with AHA (hospital characteristics and locations), and ‘Area Resources File’ (county specific information) data, n=148,117. We calculated respondents’ distance to the closest VA and non-VA hospitals and identified the non-VA market as hospitals contained within 10 miles + the distance to the closest non-VA hospital from residents’ zipcodes. Ordered probit regression assessed the impact of distance and hospital characteristics on self-reported reliance on VA (used VA only, both, non-VA only), controlling for insurance coverage and personal characteristics.

Results: 53% of enrollees live within 30 miles of a VA hospital. Enrollees live an average of 7.1 and 39.2 miles to a non–VA and VA hospital respectively, with an average of 9 non-VA hospitals in the market. The number of alternative hospitals declines as the distance from the closest VA increases. Enrollees living within 10 miles of a VA hospital have 18 non-VA hospitals within the market radius with the closest 3.4 miles away. Enrollees living more than 30 miles from a VA facility have 3 hospitals and the closest is 11 miles. The results from an ordered probit regression suggest that respondents are more likely to use VA when it is closer and when non-VA hospitals are further . Hospital characteristics affect use of VA care: respondents are more likely to use VA when the closest VA facility is a general hospital.

Conclusions: Enrollees travel farther to VA than non-VA hospitals. Enrollees living close to VA hospitals have many choices and the relative distance of the VA and non-VA is not large. The distance to VA and non-VA hospitals affects VA enrollees’ reliance on VA care.

Impact statement: Understanding VA enrollees’ geographic access to VA and non-VA hospitals can help VA provide better care to its patients.