VA Healthcare: Prioritized Access and Utilization at the Intersections of Race and Ethnicity with Gender

For U.S. military veterans, access to VA healthcare is determined by laws and policies, and involves military service factors (e.g., medals, POW, exposures), service-connected disabilities (SCDs), and income. To access VA care, veterans are assigned to one of eight priority groups (PGs) whereby veterans with higher SCD ratings, higher need, and/or low income are assigned to higher PGs. The prevalence of SCDs among veterans continues to rise and is higher among some racial and ethnic groups and female veterans. Little is known about how the structure of access to VA care relates to healthcare utilization and differences by race, ethnicity, and gender. Therefore, the purpose of this study was to characterize access to VA health care (PGs), VA healthcare utilization (outpatient care), and intersections of race, ethnicity, and gender, and to determine relationships among these concepts. A secondary analysis of healthcare administrative data from the Weight and Veterans Environment Study was used to perform this study. In Chapter I, using a cross-sectional descriptive analyses, the characterization of veterans’ PGs and outpatient care by intersections of race and ethnicity with gender is presented. Across race and ethnicity, more female veterans were in the highest PGs (SCD ratings >10%) compared to male counterparts. In contrast, the largest proportion of veterans in the lowest PG (0% rated SCDs or without SCDs and higher income) were non-Hispanic White males. Across intersections, outpatient care use was highest in the PG for catastrophically disabled veterans without SCDs. Chapter II using longitudinal panel data analyses, relationships among PGs, VA outpatient healthcare use, and intersections of race and ethnicity with gender are presented. Overall, outpatient care use was associated with PGs and intersections of race and ethnicity with gender that also moderated the effect of PGs on outpatient care use with the largest effects within the PG for catastrophically disabled veterans without SCDs. Findings from this study have implications for policy, practice, and research. Knowledge of structural access and use of VA care can inform interventions to prevent and reduce health-related effects of military service across the life course of veterans.