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Is travel distance a barrier to veterans' use of VA hospitals for medical surgical care?

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  • Mooney, Cathleen
  • Zwanziger, Jack
  • Phibbs, Ciaran S.
  • Schmitt, Susan

Abstract

Lengthy travel distances may explain why relatively few veterans in the United States use VA hospitals for inpatient medical/surgical care. We used two approaches to distinguish the effect of distance on VA use from other factors such as access to alternatives and veterans' characteristics. The first approach describes how disparities in travel distance to the VA are related to other characteristics of geographic areas. The second approach involved a multivariate analysis of VA use in postal zip code areas (ZCAs). We used several sources of data to estimate the number of veterans who had priority access to the VA so that use rates could be estimated. Access to hospitals was characterized by estimated travel distance to inpatient providers that typically serve each ZCA. The results demonstrate that travel distance to the VA is variable, with veterans in rural areas traveling much farther for VA care than veterans in areas of high population density. However, Medicare recipients also travel farther in areas of low population density. In some areas veterans must travel lengthy distances for VA care because VA hospitals which were built over the past few decades are not located close to areas in which veterans reside in the 1990s. The disparities in travel distance suggest inequitable access to the VA. Use of the VA decreases with increases in travel distance only up to about 15 miles, after which use is relatively insensitive to further increases in distance. The multivariate analyses indicate that those over 65 are less sensitive to distance than younger veterans, even though those over 65 are Medicare eligible and therefore have inexpensive access to alternatives. The results suggest that proximity to a VA hospital is only one of many factors determining VA use. Further research is indicated to develop an appropriate response to the needs of the small but apparently dedicated group of VA users who are traveling very long distances to obtain VA care.

Suggested Citation

  • Mooney, Cathleen & Zwanziger, Jack & Phibbs, Ciaran S. & Schmitt, Susan, 2000. "Is travel distance a barrier to veterans' use of VA hospitals for medical surgical care?," Social Science & Medicine, Elsevier, vol. 50(12), pages 1743-1755, June.
  • Handle: RePEc:eee:socmed:v:50:y:2000:i:12:p:1743-1755
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    Cited by:

    1. Doyle Jr., Joseph J. & Ewer, Steven M. & Wagner, Todd H., 2010. "Returns to physician human capital: Evidence from patients randomized to physician teams," Journal of Health Economics, Elsevier, vol. 29(6), pages 866-882, December.
    2. Bech, Mickael & Lauridsen, Jørgen, 2008. "Exploring the spatial pattern in hospital admissions," Health Policy, Elsevier, vol. 87(1), pages 50-62, July.
    3. Birk, Hans Okkels & Henriksen, Lars Onsberg, 2006. "Why do not all hip- and knee patients facing long waiting times accept re-referral to hospitals with short waiting time?: Questionnaire study," Health Policy, Elsevier, vol. 77(3), pages 318-325, August.
    4. Panelli, Ruth & Gallagher, Lou & Kearns, Robin, 2006. "Access to rural health services: Research as community action and policy critique," Social Science & Medicine, Elsevier, vol. 62(5), pages 1103-1114, March.
    5. Majumder, Amlan, 2014. "Economics of health care utilisation: a study of self-reported morbidity and health seeking patterns in the districts of Cooch Behar and Jalpaiguri, West Bengal, India," EconStor Books, ZBW - Leibniz Information Centre for Economics, number 110899.

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    Keywords

    Veterans Hospitalization Distance;

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