BACKGROUND: Women veterans are generally less healthy than their nonveteran female counterparts or male veterans. Accumulating evidence suggests there may be barriers to women veterans’ access to and use of Veterans Health Administration (VHA) care.
OBJECTIVE: To document perceived and/or actual barriers to care in a nationally representative sample of women veterans and examine associations with VHA use.
DESIGN: Cross-sectional telephone survey.
PARTICIPANTS: Women who are current and former users of VHA from VA’s National Registry of Women Veterans.
MEASUREMENTS: Assessments of perceptions of VHA care, background characteristics, and health service use.
RESULTS: Perceptions of VHA care were most positive regarding facility/physical environment characteristics and physician skill and sensitivity and least positive regarding the availability of needed services and logistics of receiving VHA care (M=0.05 and M=−0.10; M=−0.23 and M=−0.25, respectively). The most salient barrier to the use of VHA care was problems related to ease of use. Moreover, each of the barriers constructs contributed unique variance in VHA health care use above and beyond background characteristics known to differentiate current users from former VHA users (Odds ratio [OR]=4.03 for availability of services; OR=2.63 for physician sensitivity and skill: OR=2.70 for logistics of care; OR=2.30 for facility/physical environment). Few differences in barriers to care and their association with VHA health care use emerged for women with and without service-connected disabilities.
CONCLUSIONS: Findings highlight several domains in which VHA decisionmakers can intervene to enhance the care available to women veterans and point to a number of areas for further investigation.
women’s health veterans access to care health services research
Skinner KM, Sullivan LM, Tripp TJ, et al. Comparing the health status of male and female veterans who use VA health care: results from the VA women’s health project. Women Health. 1999;29:17–33.PubMedCrossRefGoogle Scholar
Skinner KM, Furey J. The focus on women veterans who use Veterans Administration health care: the Veterans Administration women’s health project. Mil Med. 1998;163:761–6.PubMedGoogle Scholar
Skinner KM. The VA women’s health project: identifying the health care needs of women veterans. Forum: VA Health Services Research and Development. 2000:6.Google Scholar
Furey J. Changing role of women veterans raises issues about health care service delivery. Forum: VA Health Services Research and Development. 2000:6.Google Scholar
Skinner KM, Kressin N, Frayne S, et al. The prevalence of military sexual assault among female Veterans Administration outpatients. J Interpersonal Violence. 2000;3:289–304.Google Scholar
Surís A, Lind L, Kashner M, Borman PD, Petty F. Sexual assault in women veterans: an examination of PTSD risk, health care utilization, and cost of care. Psychosom Med. 2004;66:749–56.PubMedCrossRefGoogle Scholar
Turpin RS, Darcy LA, Weaver FM, Kruse K. Assessing health care delivery to male versus female veterans. Women Health. 1992;18:81–95.PubMedCrossRefGoogle Scholar
Yano EM, Washington DL, Goldzweig C, Caffrey C, Turner C. The organization and delivery of women’s health care in Department of Veterans Affairs medical center. Women’s Health Issues. 2003;13:55–61.PubMedCrossRefGoogle Scholar
Washington DL, Caffrey C, Goldzweig C, Simon B, Yano EM. Availability of comprehensive women’s health care through Department of Veterans Affairs medical center. Women’s Health Issues. 2003;13:50–4.PubMedCrossRefGoogle Scholar
Kressin NR, Skinner K, Sullivan L, et al. Patient satisfaction with Department of Veterans Affairs health care: do women differ from men? Mil Med. 1999;164:283–8.PubMedGoogle Scholar
Miller PM, King LA, Wolfe J, King DW. Gender ideology, sensitivity, and knowledge: a model of gender awareness in VA health care. Veterans Health Syst J. 1999;4:27–30.Google Scholar
Bean-Mayberry B, Chang C, McNeil M, Hayes P, Scholle SH. Comprehensive care for women veterans: indicators of dual use of VA and non-VA providers. J Am Med Women’s Assoc. 2004;59:192–7.Google Scholar
Schuler MP, Barclay AG, Harrison B, Larson P. Psychological services offered to female veterans. J Clin Psychol. 1986;42:668–75.PubMedCrossRefGoogle Scholar
Kazis LE, Miller DR, Clark J, et al. Health-related quality of life in patients served by the Department of Veterans Affairs: results from the Veterans Health Study. Arch Intern Med. 1998;158:626–32.PubMedCrossRefGoogle Scholar
Washington DL. Challenges to studying and delivering care to special populations: the example of women veterans. J Rehabil Res Dev. 2004;41:7–9.Google Scholar
Wolfe J, Stern A, Daley J, Zaslavsky A, Roper SF, Wilson K. Changing demographic characteristics of women veterans: results from a national sample. Mil Med. 2000;165:773–80.PubMedGoogle Scholar
Department of Veterans Affairs. Disabled veterans get health care priority from VA. Available at: http://wwwl.va.gov/opa/pressrel/PressArt-Internet.cfm?id=715. Accessed June 24, 2005.Google Scholar
Department of Veterans Affairs. VA announces record budget, health care changes. Available at: http://wwwl.va.gov/visns/visn03/newsletter/pr11703.asp. Accessed June 24, 2005.Google Scholar
Melnyk KAM. Barriers: a critical review of recent literature. Nurs Res. 1988;37:196–201.PubMedGoogle Scholar
Neri MT, Kroll T. Understanding the consequences of access barriers to health care: experiences of adults with disabilities. Disabil Rehabil. 2003;25:85–96.PubMedCrossRefGoogle Scholar
Scheer J, Kroll T, Neri MT, Beatty P. Access barriers for persons with disabilities: a consumer’s perspective. J Disabil Policy Stud. 2003;13:221–30.CrossRefGoogle Scholar
Ouimette P, Wolfe J, Daley J, Gima K. Use of VA health care services by women veterans: findings from a national sample. Women Health. 2003;38:77–91.PubMedCrossRefGoogle Scholar
Fiscella K, Franks P, Clancy CM, Doescher MP, Banthin JS. Does skepticism towards medical care predict mortality? Med Care. 1999;37:409–14.PubMedCrossRefGoogle Scholar
Rosenheck R, Stolar M. Access to public mental health services: determinants of population coverage. Med Care. 1998;36:503–12.PubMedCrossRefGoogle Scholar
Holm CJ, Frank DI, Curtin J. Health beliefs, health locus of control, and women’s mammography behavior. Cancer Nurs. 1999;22:149–56.PubMedCrossRefGoogle Scholar
Salgado DM, Vogt DS, King LA, King DW. Gender Awareness Inventory-VA: a measure of ideology, sensitivity, and knowledge related to women veteran’s health care. Sex Roles. 2002;46:247–62.CrossRefGoogle Scholar
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;34:65–83.PubMedCrossRefGoogle Scholar
Yeung RYT, Leung GM, McGhee SM, Johnston JM. Waiting time and doctor shopping in a mixed medical economy. Health Econ. 2004;13:1137–44.PubMedCrossRefGoogle Scholar
Damron-Rodriguez J, White-Kazemipour W, Washington D, Villa VM, Dhanani S, Harada ND. Accessibility and acceptability of the department of veteran affairs health care: diverse veterans’ perspectives. Mil Med. 2004;169:243–50.PubMedGoogle Scholar
Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey: manual & interpretation, The Health Institute, New England Medical Center, Boston, 1993;3–13.Google Scholar
Stern A, Wolfe J, Daley J, Zaslavsky A, Roper SF, Wilson K. Changing demographic characteristics of women veterans: results from a national sample. Mil Med. 2000;165:773–80.PubMedGoogle Scholar