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Publication Briefs

Reasons Why Women Veterans Leave or Stay in VA Healthcare

Women Veterans new to VA are the fastest growing cohort of new VA users, but given their numeric minority status (about 7.5% of VA patients), concerns have been raised about their rate of attrition. Further, there have been many changes in VA healthcare over the past decade, such as a shift to a patient-centered medical home model, the implementation of comprehensive women’s healthcare policy, and expansion of VA-paid community-based care. This study sought to characterize women Veterans’ decision-making related to departing from (attriting) or continuing to use VA – and to explore factors that help retain/attract women to the VA healthcare system. Semi-structured interviews were conducted with 51 women Veterans (25 attriters, 26 non-attriters) from 2017-2018. Transcribed interviews were coded and analyzed for women’s decision-making, contexts, and recommendations related to healthcare use. Women Veterans were recruited from the Women’s Health Evaluation Initiative’s database; investigators identified those who used VA outpatient care in FY2011 and who were new to VA. Attrition was defined as having no VA healthcare use (VA outpatient/inpatient or VA-purchased community care) during years 2 and 3 following the Veteran’s first 2011 visit (i.e., thru 2014).


  • Women Veterans described complex reasons why they left or continued using VA, with cost and affordability playing an important role even in considerations of returning to VA after a long hiatus.
  • Personal experiences with VA care were regarded similarly by both attriters and non-attriters and considered greatly influential in their decision to use VA or not.
  • Care experiences that influenced women’s decisions not to continue using VA included: strained patient-provider interactions (e.g., feelings of mistrust); disruptive provider turnover; service-connection compensation/pension claim challenges; billing and care coordination disputes regarding VA-purchased care; burdensome access (i.e., clinic-initiated appointment cancellations and rescheduling problems); inconvenient appointment times; and travel distance to the main medical center.
  • More than one-third of women originally categorized as attriters described subsequently re-entering or planning to re-enter VA care.
  • Suggestions to reduce attrition included increasing outreach, improving access, and continuing to tailor care delivery to women Veterans’ needs.


  • Understanding drivers of patients’ decisions to use or not use VA is critical for the development of strategies to improve retention of current patients and optimize health outcomes for Veterans.


  • Study participants were asked to recollect decision-making processes from years after the fact, and therefore may not have been able to remember all of the reasons why they left VA healthcare.

This study was supported by HSR&D (CRE 12-019). Ms. Chrystal and Ms. Gammage and Drs. Dyer, Moreau, Washington, Yano, and Hamilton are based at HSR&D’s Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP) in Los Angeles, CA; Dr. Frayne, Ms. Saechao, and Mr. Berg are based at HSR&D’s Center for Innovation to Implementation (Ci2i) in Palo Alto, CA.

Chrystal J, Frayne S, Dyer K, et al. Women Veterans’ Attrition from the VA Healthcare System. Women’s Health Issues. December 28, 2021:S1049-3867(21)00186-9; 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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