VA Travel Reimbursement Increases Outpatient Visits
BACKGROUND:
With an increasing number of military recruits returning to rural areas, VA has made reducing barriers to healthcare access for rural Veterans one of its top priorities. Effective February 1, 2008, in an effort to increase access to VA healthcare facilities for Veterans living in rural areas, VA increased the mileage reimbursement rate from 11 cents per mile to 28.5 cents per mile. At the same time, the deductibles applied to claims for travel reimbursement increased from $3.00 to $7.77 for a one-way trip, and from $6.00 to $15.54 for a round trip, with the monthly cap increasing from $18.00 to $46.62. The travel reimbursement acts as a subsidy that should reduce the price of VA healthcare for Veterans, thereby increasing their use of VA care. This study examined the effects of this policy change on utilization of outpatient, inpatient, and pharmacy services in the 10.5 months before the reimbursement rate increase and the 10.5 months after the rate increase. Using VA data, investigators identified a random sample of VA healthcare users (n=250,958) who had at least one VA outpatient encounter between 3/06 and 3/07. Investigators then examined the association between the reimbursement increase and whether patients used VA services, the number of times the service was used, and the cost incurred.
FINDINGS:
- After the reimbursement rate increase, eligible Veterans (n=192,559) at all distances were 7% more likely to have at least one VA outpatient visit and had 3% more outpatient visits compared to Veterans who were not eligible for the travel reimbursement. The increased reimbursement was associated with slightly larger increases in outpatient costs to provide care to Veterans who lived farther away from VA facilities compared to those who lived closer, e.g., costs rose 3% to provide care to Veterans living closer than 75 miles and 5% for those living farther than 75 miles from a VA healthcare facility.
- The odds of having a prescription filled at a VA pharmacy increased by at least 4% for Veterans across all distance definitions, with patients living farther than 50 miles away experiencing the largest increase at 9%. The reimbursement rate also was associated with a significant increase in pharmacy costs to provide medications to Veterans living farther than 50 and 75 miles from a VA facility.
- Inpatient visits remained generally unaffected, and there was no significant increase in cost.
- The effect of increased healthcare use on overall health outcomes is unclear; authors suggest that future research examine this and other questions related to the health consequences of this policy.
LIMITATIONS:
- There may have been some misclassification of Veterans’ eligibility for travel reimbursement.
- Travel reimbursement increased a second time on 11/17/08 – from 28.5 to 41.5 cents per mile. The analyses reported here focus solely on the effects of the first reimbursement (2/1/08).
AUTHOR/FUNDING INFORMATION:
Drs. Nelson, Hicken, and Rupper are part of HSR&D’s Salt Lake Informatics, Decision Enhancement, and Surveillance Center, Salt Lake City, UT. Dr. West is part of the VA White River Junction Health Care System, White River Junction, VT.
Nelson R, Hicken B, West A, and Rupper R. The Effect of Increased Travel Reimbursement Rates on Health Care Utilization in the VA. The Journal of Rural Health August 24, 2011;e-pub ahead of print.
