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Publication Briefs

Perceived Urgency, Proximity, Personal Preference, and Cost Cited as Biggest Influencers of Choosing VA vs. Non-VA ED Care

While most civilians live within an hour of an emergency department (ED), many Veterans must travel greater distances to reach VA EDs. To ensure the timely delivery of emergency care to Veterans, VA offers emergency care services in its own facilities and, increasingly, purchases care for Veterans in non-VA (community) ED settings. Although in recent years, emergency care coverage has become the single largest contributor to VA community care spending, no study to date has examined Veteran decision-making as it relates to ED setting choice. This study identified and described the reasons why Veterans choose VA vs. non-VA emergency care settings. From December 2018 through March 2020, researchers interviewed 50 geographically diverse Veterans (78% male, 48% 65 years or older, 62% dual users of VA and community ED care) who had used emergency care in the prior six months, to understand the factors Veterans consider when deciding where to obtain ED care. Interview transcripts were summarized and categorized to identify common patterns in Veterans’ decision-making.


  • When choosing between VA and non-VA EDs, Veterans described three distinct patterns of decision-making: 1) choosing the closest ED (often community) for acute conditions; 2) traveling farther for VA care due to preference and financial coverage; and 3) selecting VA when both types of ED care were equidistant.
  • Perceptions of community resources, condition-specific needs, financial considerations, and personal preferences dominated Veterans’ ED care decision-making.
  • Most Veterans (74%) rated their acuity as high, and the self-perceived severity/urgency of their condition was the most cited factor influencing where Veterans decided to go for ED care.


  • As the number of Veterans treated in non-VA EDs continues to rise, understanding the challenges they face when deciding where to receive care can help VA and non-VA ED providers, as well as policy makers, to develop strategies to ensure that Veterans receive the most appropriate and timely care.


  • While researchers stratified their sample by sociodemographic factors, they did not delve into the potential interactions or relationships between these stratified variables and setting choice.
  • This study focused on Veteran perspectives; including other parties (e.g., family members, paramedics, primary and emergency care providers), may provide additional insight on decision-making and preferences.
    This study was funded by HSR (IIR 16-266). Drs. Vashi and Asch and Mss. Wong and Egelfeld are with HSR’s Center for Innovation to Implementation (Ci2i). Dr. Nevedal is with HSR’s Center for Clinical Management Research (CCMR).

    Vashi AA, Wong EP, Egelfeld JR, Asch SM, Nevedal AL. Why Veterans Choose VA Versus Non-VA Emergency Care: A Qualitative Study. Military Medicine. May 18, 2024;online ahead of print.

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    What are HSR Publication Briefs?

    HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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