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HSR&D 2004 National Meeting Abstracts

2061. Veteran's Willingness to Travel for Inpatient and Outpatient Medical Care
Ciaran S Phibbs, PhD, VA Palo Alto Healthcare System and Stanford University, J Zwanziger, University of Illinois, CM Kane, University of Rochester, AK Schmitt, VA Palo Alto Healthcare System

Objectives: Previous work has found that travel time or distance affects demand for inpatient or outpatient care. No one, however, has examined this issue for both types of care using the same patients. This study looks at how distance affects veterans’ use of inpatient and outpatient VA medical care.

Methods: Data from the US Census, the Survey of Veterans, and VA pension data were used to estimate the number of veterans in each ZIP code eligible for VA health care. VA utilization data were used to determine the number of veterans in each ZIP who used VA care. The regular non-VA providers of health care to residents of each ZIP were identified from Medicare data. Regression models were used to examine how distance to VA and non-VA providers affected veterans’ use of VA services.

Results: Most eligible veterans do not receive care at VA (use rates, 5% inpatient, 20% outpatient). For inpatient care, use fell rapidly as distance increased up to 15 miles, but had very limited effect for longer distances. The use of outpatient care was even more sensitive to added distance, especially for short distances. Added distance had a greater effect on the number of outpatient visits than it did on the decision to use any VA outpatient care.

Conclusions: While travel distance affects the demand for both outpatient and inpatient care, outpatient care is more sensitive to additional travel.

Impact: These results support the recent VA efforts to improve veterans’ geographic access to outpatient care.