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Publication Briefs

Veterans Eligible for VA Purchased Healthcare Based on Distance from VA Facilities Face Shortage of Non-VA Providers

Approximately 22-30% of VA healthcare enrollees live in rural areas, and VA has worked to improve access to care for these Veterans using many strategies, including building community-based outpatient clinics in rural communities, reimbursing Veterans for travel to VA care sites, and promoting telehealth. In addition, the Choice Act directs VA to purchase care from non-VA providers for Veterans who live more than 40 miles from the nearest VA healthcare facility. This study examined the potential impacts of these reforms on Veterans and healthcare providers. Investigators identified VA healthcare users (n=416,338) eligible for purchased care based on distance to VA facilities, most living in rural settings. Combining 2013 administrative data on VA users with county-level data on rurality, non-VA provider availability, population, household income, and population health status, investigators then assessed the availability of non-VA healthcare providers in counties where these Veterans resided.


  • Initiatives to purchase care for Veterans living more than 40 miles from VA facilities may not significantly improve their access to care, as these areas are underserved by non-VA providers.
    • About 16% of these Veterans lived in areas where there was a shortage of primary care providers, while 70% lived in areas where there was a shortage of mental healthcare providers.
    • The majority of VA users eligible for purchased care lived in counties with no psychiatrists, cardiologists, pulmonologists, neurologists, PM&R specialists, or community mental health centers.
    • Nearly half of these Veterans (47%) lived in counties with no community health center.
  • Veterans eligible for purchased care based on distance were much more likely than the general population to live in counties with a median household income < $40,000 per year (40% vs. 11%) and very poor population health status (28% vs. 10%).


  • VA should continue to develop telehealth programs and other strategies to deliver care to Veterans in rural areas underserved by both community and VA providers. Such programs are a necessary complement to initiatives to purchase in-person care from community providers.


  • This study examined the availability of non-VA providers at the county level, and in some cases providers may have existed in relatively nearby communities in neighboring counties.
  • Associations apparent at the county level may not hold at the individual level.
  • The administrative data on VA enrollees were from 2013 (most recent data available at the time).

This study was partly funded by HSR&D, and Dr. Ohl was an HSR&D Career Development Awardee (CDA 11-211) at the time of this work. Drs. Ohl and Thurman are part of HSR&D's Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City, IA.

PubMed Logo Ohl M, Carrell M, Thurman A, et al. Availability of Healthcare Providers for Rural Veterans Eligible for Purchased Care under the Veterans Choice Act. BMC Health Services Research. May 29, 2018;18(1):315.

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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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