Study Examines Racial/Ethnic and Gender Variations in Veteran Satisfaction with VA Healthcare

BACKGROUND:
Measures of patient satisfaction are used to grade the effectiveness of medical providers and healthcare systems, and increasingly are linked to provider and hospital payments. This study of Veterans' satisfaction with outpatient, inpatient, and specialist care in a diverse sample of Veterans from predominantly minority-serving VAMCs sought to better understand racial/ethnic and gender variations in healthcare satisfaction. Telephone interviews were conducted with 1,222 Veterans (616 were female) who received care from 25 predominantly minority-serving VAMCs between June 2013 and January 2015. Study participants included 421 white Veterans, 389 black Veterans, and 396 Hispanic Veterans. Satisfaction with healthcare was assessed in 16 domains, such as outpatient care, access to care, pharmacy services, pain management, women's health, respect, specialist care, mental healthcare, cost of care, and communication.

FINDINGS:

• Results show generally high levels of healthcare satisfaction across 16 domains, with 83% of respondents somewhat or very satisfied with VA healthcare overall.
• The highest satisfaction ratings were reported for costs, outpatient facilities, and pharmacy services (74% to 76% were very satisfied); the lowest ratings were reported for access to care, pain management, and mental healthcare (21% to 24% were less than satisfied).
• Contrary to previous studies, there was little evidence of racial, ethnic, or gender disparities in satisfaction with care at minority serving VAMCs. However, some differences were identified that could be targeted for gender- and culturally- tailored interventions.
• There was some evidence of gender differences in satisfaction levels by race/ethnicity. For example, black females were more likely than black males to be less than (vs. very) satisfied with pharmacy services. White females were more likely than white males to be somewhat (vs. very) satisfied with outpatient care, cost of care, and respect. In contrast, black females were less likely than black males to be somewhat (vs. very) satisfied with specialist care.

IMPLICATIONS:

• Findings will help VA improve healthcare experiences for an increasingly diverse patient population.

LIMITATIONS:

• Results do not generalize to all VA facilities and preclude quantifying the magnitude of between-facility differences in satisfaction by race/ethnicity or gender on a national level.
• This study involved multiple comparisons, and had limited power to detect differences in domains that are applicable to smaller subsets of Veterans, such as inpatient care.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (SDR 13-245 and IIR 10-144). Dr. Zickmund is part of HSR&D's Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) in Salt Lake City, UT. Drs. Burkitt and Gao are part of HSR&D's Center for Health Equity Research & Promotion (CHERP) in Pittsburgh and Philadelphia, PA.

Zickmund S, Burkitt K, Gao S, et al. Racial, Ethnic, and Gender Equity in Veteran Satisfaction with Health Care in the Veterans Affairs Health Care System. Journal of General Internal Medicine. March 2018;33(3):305-31.