Improving Veterans' Access to Care

Access to healthcare has been identified as a critical issue by the medical community, as well as by those in the veteran's affairs deparement. Historically, VA patients were able to obtain the healthcare they needed within an appropriate time frame. New research provides us with an updated concept of access that places a greater focus on post-access outcomes such as patient satisfaction, symptom levels, and functioning.

Most commonly studied was the association between distance from a VA facility and healthcare use, primarily outpatient or mental health services used. Evidence showed that increased distance from a VA facility was associated with decreased healthcare use. For those living 60 miles or more away from a facility, there was little change in the data received.
David Goldstein investigates the dilemma veterans in rural areas are facing, such as Frank Munk who must drive nearly 300 miles to a Department of Veterans Affairs hospital. Instead, Munk pays $2,500 out of pocket on a private doctor. The VA won't pay for a veteran to see an out-of-network doctor if the same care is available within the system - even if it's more convenient. 41% of enrollees in the VA health system (that's about 3 million veterans) are living in rural areas, unable to get the care they qualify for.

An internal audit of the efforts to improve health care for rural veterans concluded that the VA "lacked reasonable assurance" that its use of $273 million actually "improved access and quality of care" for veterans. Due to a lack of project performance measures, the VA office was unable to tell how effective their projects actually were.

In an attempt to cut costs yet still provide care, the VA has been using telemedicine to reach out to veterans from all war eras. Telemedicine allows patient to be diagnosed and treated via electronic communication. Another way rural veterans are able to receive medical care is through a network of about 800 community-based outpatient clinics that provide basic medical care such as chechups, X-rays and prescriptions. Yet for those veterans who have chronic or severe medical problems, the options for care are few.

While there appears to be a general agreement that VA hospitals provide good medical care, the system has been under stress due to the wars in Iraq and Afghanistan. Few expected these wars would last so long, or that there would be such a flood of patients, with severe injuries. Rural America is home to more than a third of the Iraq and Afghanistan veterans who are enrolled in the VA. VA spokesman Josh Taylor says the department is committed to expanding access to rural veterans. While the physical signs of battle are most often quickly cared for, the psychological wounds will require years, or even a lifetime to heal.

It was the veteran's choice to step up and serve our country, and now it is the VA's responsibility to provide the care they deserve.


Goldstein, David. (2011, June 7). For veterans in rural areas, health care can be a battle. McClatchy Newspapers.