Post-MISSION Act Racial/Ethnic Disparities Exist in Use and Wait Times for VA and Community Care Primary Care
BACKGROUND:
The 2018 VA MISSION Act was implemented to increase timely access to care by expanding Veterans’ opportunities to receive VA-purchased care in the community (“Community Care,” “CC”). Although a few studies have examined the early impact of the MISSION Act on primary and specialty care wait times, it is unknown whether utilization of CC for primary care continued to increase during the later MISSION Act period, and how that affected wait times. It is also unknown whether the MISSION Act differentially affected CC primary care access among rural/urban Black and Hispanic relative to White Veterans. This study used VA and CC outpatient and consult data for FY2021–FY2022 to examine whether utilization of and wait times for primary care differed between Black and Hispanic Veterans compared to White Veterans in rural and urban areas post-MISSION. The main measures were VA and CC primary care utilization measured by primary care visits (utilization cohort) and VA and CC primary care access measured by mean wait times (access cohort). During the study period, 5,046,087 Veterans (20% Black, 8% Hispanic, 73% White) used primary care, and there were 468,246 primary care consults.
FINDINGS:
- Black and Hispanic Veterans waited significantly longer for primary care in CC, but Hispanic Veterans in urban areas had shorter wait times relative to White Veterans. Black Veterans had shorter wait times in VA than White Veterans in rural and urban areas.
- Black and Hispanic Veterans were less likely to use CC for primary care, regardless of rurality status.
- Utilization of primary care increased for all 3 race/ethnicity groups, more so in CC than VA.
- Most Veterans (93%) received primary care exclusively in VA.
- The overall mean wait time was 33 days. Despite decreases in wait times over time, primary care wait times remained longer in CC than in VA. However, wait times in both settings exceeded the 20-day wait time standards established in the MISSION Act.
IMPLICATIONS:
- A better understanding of the sources of healthcare disparities (e.g., unavailability of CC clinicians in areas where Black and Hispanic Veterans live) is needed to inform strategies to ensure that all Veterans obtain timely care.
LIMITATIONS:
- The study lacked a subjective measure of Veterans’ perceptions of primary care access.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR (SDR 20-390-A). Drs. Rosen, Shwartz, and Gurewich, and Ms. Beilstein-Wedel are with HSR’s Center for Healthcare Organization and Implementation Research (CHOIR). Dr. Davila is with the VA Iowa City Health Care System. Dr. Rosen is also supported through an HSR Senior Research Career Scientist Award.
Rosen AK, Beilstein-Wedel E, Shwartz M, Davila H, Gurewich D. Racial and Ethnic and Rural Variations in Access to Primary Care for Veterans Following the MISSION Act. JAMA Health Forum. June 21, 2024;5(6):e241568.
