Veterans represent less than 10% of the population, but this key demographic group has a higher burden of illness compared to civilians and accounts for approximately 20.4 million people in the United States.1,2 Veterans not only represent a unique subset of the population in regard to their specific health care needs, but they also differ in how their health care is structured and insured.
The majority of military veterans (62%) receive health care delivered by the Veterans Health Administration (VHA), which is designed to ensure military veterans can receive timely access to health services.3However, studies show increased delays in veterans seeking necessary healthcare compared to the general population. Further investigation as to the cause of this delay indicates that veterans have concerns regarding ability of the VHA medical facilities’ ability to provide health services in a timely manner.4This long-standing issue needs to be addressed, since there have been some cases in which delays in care have resulted in serious preventable harm to veterans.
Perceived Barriers to Healthcare Access
Nearly 3 out of 10 veterans have reported delays in seeking medical care they thought they needed in the past year.4Results from a survey to assess veterans’ perceived barriers to seeking healthcare found some common themes that emerged, which included: increased geographic distance from a VHA medical center, lengthy wait times, needed services being unavailable at their nearby VHA medical facility, difficulty making appointments, and concern about social exclusion and stigma.4-6The study also discovered that respondents who reported experiencing a barrier to care had increased odds of not using a VHA medical center in the future.6These findings suggest that certain perceived barriers can be used to predict whether a veteran will decide to delay seeking health care from a VHA medical center.
Addressing the Issue: Veterans Choice Program and VA Mission Act
The Veterans Choice Program was enacted in 2014 to address the challenges with veterans’ access to care at VHA medical facilities.5Through this program eligible veterans could be referred by a Third Party Administrator (TriWest or Health Net) to receive health care from a community provider when not readily accessible at VHA facilities.5
Certain outlined criteria needed to be met in order for a veteran to be eligible for participation in the Choice Program, which can be found through the GAO’s website at https://www.goa.gov. According to these criteria, a long wait time for health care is considered met when the next available medical appointment is more than 30 days from the veteran’s or their doctor’s preferred appointment date.5Limitations in data have made it difficult to determine whether the Veterans Choice program successfully addressed delays in veterans receiving care, but initial data indicated further modifications to the program were warranted. VHA and GOA analysis on timeliness of care within the Choice Program found it took an average of 51-70 calendar days for veterans to receive care.5
For these reasons, the VA Choice Program ended on May 31, 2018 and further reforms are now being implemented. The VA Mission Act was signed into law on June 6, 2018 requiring the VHA to work on criteria such as wait times for appointments, quality of care, and distance to a VHA facility. Under this new act the VA has been tasked with making certain that veterans “do not experience a lapse in health care services.” The VA is now also required to enter into contracts with private networks to ensure veterans can receive health care when warranted.7
Access to timely health care appointments is an essential component of quality health care for both civilians and veterans alike. Unfortunately, delays in military veterans receiving care is an established issue that could very well be negatively affecting patients’ morbidity, mortality, and quality of life.
References:
- Bialik K. The changing face of America’s veteran population. Pewresearch.org. http://www.pewresearch.org/fact-tank/2017/11/10/the-changing-face-of-americas-veteran-population/. Published November 10, 2017. Accessed February 13, 2019.
- Misra-Hebert AD, Santurri L, DeChant R, et al. Understanding the Health Needs and Barriers to Seeking Health Care of Veteran Students in the Community. South Med J. 2015;108(8):488-493. doi:10.14423/SMJ.0000000000000326
- Analysis of VA Health Care Utilization among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans. Publichealth.va.gov. https://www.publichealth.va.gov/docs/epidemiology/healthcare-utilization-report-fy2015-qtr1.pdf. Published June 2015. Accessed February 13, 2019.
- Science Daily: Lee D, Begley CE. Delays in Seeking Health Care: Comparison of Veterans and the General Population. Journal of Public Health Management and Practice. 2017;23(2):160-168. doi:10.1097/PHH.0000000000000420
- Veterans choice program: Improvements needed to address access-related challenges as VA plans consolidation of its community care programs. Gao.gov. https://www.gao.gov/assets/700/692271.pdf. Published June 2018. Accessed February 10, 2019.
- Elnitsky CA, Andresen EM, Clark ME, McGarity S, Hall CG, Kerns RD. Access to the US Department of Veterans Affairs health system: self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom. BMC Health Serv Res. 2013;13:498. doi:10.1186/1472-6963-13-498
- VA mission act signed into law. Militarybenefits.info. https://militarybenefits.info/va-mission-act/. Accessed February 13, 2019.