Differences in use of Veterans Health Administration and non‐Veterans Health Administration hospitals by rural and urban Veterans after access expansions

• Published in: The Journal of rural health 2024-06, Vol.40 (3), p.446-456
• Main Authors: Dizon, Matthew P., Kizer, Kenneth W., Ong, Michael K., Phibbs, Ciaran S., Vanneman, Megan E., Wong, Emily P., Zhang, Yue, Yoon, Jean
• Format: Article
• Language: English
• Subjects: Access; access to care; Adult; Aged; Cross-Sectional Studies; Female; Generalized linear models; Health; Health care; Health Services Accessibility - standards; Health Services Accessibility - statistics & numerical data; health services research; Hospital administration; Hospitalization; Hospitals; Hospitals, Veterans - statistics & numerical data; Humans; Inpatient care; Linear analysis; Male; Management; medical care; Middle Aged; Military hospitals; Patient admissions; probability; regression analysis; Rural areas; rural health; Rural Population - statistics & numerical data; Rural urban differences; Sociodemographics; Statistical analysis; Statistical models; Travel; United States; United States Department of Veterans Affairs - organization & administration; United States Department of Veterans Affairs - statistics & numerical data; Urban Population - statistics & numerical data; utilization of health services; Veterans; Veterans - statistics & numerical data
• ISSN: 0890-765X; 1748-0361; 1748-0361
• DOI: 10.1111/jrh.12812

Purpose To examine changes in rural and urban Veterans’ utilization of acute inpatient care in Veterans Health Administration (VHA) and non‐VHA hospitals following access expansion from the Veterans Choice Act, which expanded eligibility for VHA‐paid community hospitalization. Methods Using repeated cross‐sectional data of VHA enrollees’ hospitalizations in 9 states (AZ, CA, CT, FL, LA, MA, NY, PA, and SC) between 2012 and 2017, we compared rural and urban Veterans’ probability of admission in VHA and non‐VHA hospitals by payer over time for elective and nonelective hospitalizations using multinomial logistic regression to adjust for patient‐level sociodemographic features. We also used generalized linear models to compare rural and urban Veterans’ travel distances to hospitals. Findings Over time, the probability of VHA‐paid community hospitalization increased more for rural Veterans than urban Veterans. For elective inpatient care, rural Veterans’ probability of VHA‐paid admission increased from 2.9% (95% CI 2.6%‐3.2%) in 2012 to 6.5% (95% CI 5.8%‐7.1%) in 2017. These changes were associated with a temporal trend that preceded and continued after the implementation of the Veterans Choice Act. Overall travel distances to hospitalizations were similar over time; however, the mean distance traveled decreased from 39.2 miles (95% CI 35.1‐43.3) in 2012 to 32.3 miles (95% CI 30.2‐34.4) in 2017 for rural Veterans receiving elective inpatient care in VHA‐paid hospitals. Conclusions Despite limited access to rural hospitals, these data demonstrate an increase in rural Veterans’ use of non‐VHA hospitals for acute inpatient care and a small reduction in distance traveled to elective inpatient services.