Skip to main content


Log in

Access to Care for Women Veterans: Delayed Healthcare and Unmet Need

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript



Timely access to healthcare is essential to ensuring optimal health outcomes, and not surprisingly, is at the heart of healthcare reform efforts. While the Veterans Health Administration (VA) has made improved access a priority, women veterans still underutilize VA healthcare relative to men. Eliminating access disparities requires a better understanding of the barriers to care that women veterans’ experience.


We examined the association of general and veteran-specific barriers on access to healthcare among women veterans.


Cross-sectional, population-based national telephone survey of 3,611 women veterans.


Delayed healthcare or unmet healthcare need in the prior 12 months.


Of women veterans, 19% had delayed healthcare or unmet need, with higher rates in younger age groups (36%, 29%, 16%, 7%, respectively, in 18–34, 35–49, 50–64, and 65-plus age groups; p < 0.001). Among those delaying or going without care, barriers that varied by age group were: unaffordable healthcare (63% of 18–34 versus 12% of 65-plus age groups); inability to take off from work (39% of those <50); and transportation difficulties (36% of 65-plus). Controlling for age, race/ethnicity, regular source of care, and health status, being uninsured (OR = 6.5; confidence interval [CI] 3.0–14.0), knowledge gaps about VA care (OR = 2.1; 95% CI 1.1–4.0), perception that VA providers are not gender-sensitive (OR = 2.4; CI 1.2–4.7), and military sexual assault history (OR = 2.1; CI 1.1–4.0) predicted delaying or foregoing care, whereas VA use and enrollment priority did not.


Both general and veteran-specific factors impact women veterans’ access to needed services. Many of the identified access barriers are potentially modifiable through expanded VA healthcare and social services. Health reform efforts should address these barriers for VA nonusers. Efforts are also warranted to improve women veterans’ knowledge of availability and affordability of VA healthcare, and to enhance the gender-sensitivity of this care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1

Similar content being viewed by others


  1. Department of Veterans Affairs. Veterans Health Care: Leading the Way to Excellence. Universal Services Task Force Report. Washington, DC: Department of Veterans Affairs; Feb. 2009.

  2. Department of Veterans Affairs, Office of Public and Intergovernmental Affairs. President Obama’s 2010 Spending Plan Initiates Transformation for VA Services. Available at:, or Accessed June 8, 2011.

  3. Hayes P, Krauthamer M. Changing the face of health care for women veterans. Fed Pract. 2009;26(2):8–10.

    Google Scholar 

  4. Dept of Veterans Affairs, Office of Policy and Planning. Market Penetration: Current Year Users Divided by Projected Living Veteran Population that Year. VetPOP 2003–2007. Washington, DC: US Dept of Veterans Affairs, Office of Policy and Planning; 2008.

  5. Department of Veterans Affairs. Provision of Primary Care to Women Veterans. Report of the Under Secretary for Health Workgroup. Washington, DC: Department of Veterans Affairs; Nov. 2008.

  6. Washington DL, Yano EM, Simon B, Sun S. To use or not to use – What influences why women veterans choose VA healthcare? J Gen Intern Med. 2006;21(Suppl 3):S11–8.

    Article  PubMed  Google Scholar 

  7. Hoff RA, Rosenheck RA. Female veterans’ use of department of Veterans Affairs health care services. Med Care. 1998;36:1114–9.

    Article  PubMed  CAS  Google Scholar 

  8. Romeis JC, Gillespie KN, Thorman KE. Female veterans’ use of health care services. Med Care. 1988;26:589–95.

    Article  PubMed  CAS  Google Scholar 

  9. Washington DL, Sun S, Canning M. Creating a sampling frame for population-based veteran research: Coverage and overlap of VA and non-VA databases. J Rehabil Res Dev. 2010;47(8):763–71.

    Article  PubMed  Google Scholar 

  10. Andersen R. A behavioral model of families’ use of health services. Research series No. 25. Chicago: Center for Health Administration Studies; 1968.

    Google Scholar 

  11. Aday LA, Andersen R. A framework for the study of access to medical care. Heal Serv Res. 1974;9:208–20.

    CAS  Google Scholar 

  12. Andersen R. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10.

    Article  PubMed  CAS  Google Scholar 

  13. Washington DL, Kleimann S, Michelini AN, Kleimann KM, Canning M. Women veterans’ perceptions and decision-making about VA health care. Mil Med. 2007;172:812–7.

    PubMed  Google Scholar 

  14. United States Department of Agriculture, Economic Research Service. Measuring Rurality: Rural-Urban Continuum Codes. Updated April 28, 2004. Available at: Accessed June 8, 2011.

  15. Agency for Healthcare Research and Quality (AHRQ). CAHPS Health Plan Survey 4.0: Adult Commercial Instrument, CAHPS® Health Plan Survey and Reporting Kit 2008. Rockville (MD): AHRQ; 2008. Available at Accessed June 8, 2011.

  16. National Committee for Quality Assurance. HEDIS Protocol for Administering CAHPS 20H Survey. Washington, DC: HEDIS; 1999.

    Google Scholar 

  17. StataCorp. Stata: Release 11. Statistical Software. College Station, TX: StataCorp LP; 2009.

    Google Scholar 

  18. Millman M, ed. Access to health care in America. Washington, DC: National Academy Press; 1993.

    Google Scholar 

  19. 111th United States Congress. Patient Protection and Affordable Care Act (Public Law 111–148), and Health Care and Education Reconciliation Act of 2010 (Public Law 111–152). Available at: Accessed June 8, 2011.

  20. Chen J, Hou F. Unmet needs for health care. Health Rep. 2002;13(2):23–34.

    PubMed  Google Scholar 

  21. Diamant AL, Hays RD, Morales LS, et al. Delays and unmet need for health care among adult primary care patients in a restructured urban public health system. Am J Public Health. 2004;94:783–9.

    Article  PubMed  Google Scholar 

  22. Hussey P, Anderson G, Berthelot JM, et al. Trends in socioeconomic disparities in health care quality in four countries. Int J Qual Health Care. 2008;20(1):53–61.

    Article  PubMed  Google Scholar 

  23. Raleigh VS, Hussey D, Seccombe I, Hallt K. Ethnic and social inequalities in women's experience of maternity care in England: results of a national survey. J R Soc Med. 2010;103(5):188–98.

    Article  PubMed  CAS  Google Scholar 

  24. Washington DL, Villa V, Brown A, Damron-Rodriguez J, Harada N. Racial/ethnic variations in veterans’ ambulatory care use. Am J Public Health. 2005;95(12):2231–7.

    Article  PubMed  Google Scholar 

  25. Washington DL, Bean-Mayberry B, Mitchell MN, Riopelle D, Yano EM. Tailoring VA primary care to women veterans: association with patient-rated quality and satisfaction. Women’s Health Issues. 2011 Jul-Aug;21(4 Suppl):S112–9.

  26. Vogt DS, Stone ER, Salgado DM, King LA, King DW, Savarese VW. Gender awareness among Veterans Administration health-care workers: existing strengths and areas for improvement. Women Health. 2001;34(4):65–83.

    Article  PubMed  CAS  Google Scholar 

  27. Mattocks KM, Skanderson M, Goulet JL, et al. Pregnancy and mental health among women veterans returning from Iraq and Afghanistan. J Women’s Health. 2010;19(12):2159–66.

    Article  Google Scholar 

  28. Bean-Mayberry BA, Chang CH, McNeil MA, Whittle J, Hayes PM, Scholle SH. Patient satisfaction in women’s clinics versus traditional primary care clinics in the Veterans Administration. J Gen Intern Med. 2003;18:175–81.

    Article  PubMed  Google Scholar 

  29. Bird CE, Rieker PP. Gender and health. The effects of constrained choices and social policies. New York, NY: Cambridge University Press; 2008.

    Google Scholar 

  30. Department of Veterans Affairs, Women Veterans Health Strategic Healthcare Group. Findings from the National Survey of Women Veterans – Brief Summary Report for Senate Veterans Affairs Committee. Washington, DC; July 2010.

  31. Department of Veterans Affairs, Veterans Health Administration. VHA Handbook 1330.01, Health care services for women veterans. 2010, May 21. Available at:, or Accessed June 8, 2011

Download references


This study was funded by the Department of Veterans Affairs (VA) Office of Public Health and Environmental Hazards, Women Veterans Health Strategic Healthcare Group, and the VA Health Services Research and Development (HSR&D) Service (#SDR-08-270). Dr. Yano is supported by a VA HSR&D Research Career Scientist award (#RCS-05-195). Dr. Bean-Mayberry was supported by a VA HSR&D Research Career Development Transition award (#RCD 02–039) during this study. Dr. Washington had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors gratefully acknowledge Mark Canning for project management, Julia Yosef, MA for assistance with survey fieldwork, Su Sun, MPH for assistance with data management, and Michael Mitchell, PhD, for statistical assistance. The views expressed within are solely those of the authors, and do not necessarily represent the views of the Department of Veterans Affairs or the United States government.

Conflicts of Interest

All authors are employed by the Department of Veterans Affairs. Drs. Washington, Bean-Mayberry, and Yano receive research funding from the VA Health Services Research and Development Service. Drs. Washington and Yano receive funding from the VA Office of Patient Care Services.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Donna L. Washington MD, MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Washington, D.L., Bean-Mayberry, B., Riopelle, D. et al. Access to Care for Women Veterans: Delayed Healthcare and Unmet Need. J GEN INTERN MED 26 (Suppl 2), 655 (2011).

Download citation

  • Published:

  • DOI: