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Publication Briefs

During Pandemic, Black and Hispanic Veterans Experienced Greater Access Barriers to VA Care Compared to White Veterans


BACKGROUND:
The impact of the COVID-19 pandemic brought access to care disparities into sharper focus. In a national sample of adults in the US, an estimated 41%reported delayed care or avoided care because of the COVID-19 pandemic, with delayed care significantly higher for Black and Hispanic adults. This cross-sectional study sought to determine whether wait times increased differentially for Black and Hispanic compared with White Veterans for VA outpatient orthopedic and cardiology services from the pre–COVID-19 to COVID-19 periods given concurrent MISSION implementation, which further expanded Veterans’ options for community care. Investigators focused on cardiology and orthopedic services because they are two of the most frequently used in both VA and community care. Using VA data, investigators identified 1,162,148 Veterans (81% men and 19% women) who received a new-patient consultation for orthopedics and/or cardiology specialty services from FYs 2019-2021. Investigators also examined patient sociodemographics and whether they lived in a rural setting.

FINDINGS:

  • National wait time disparities increased significantly from the pre-COVID-19 period to the COVID-19 period for Black and Hispanic Veterans for orthopedic During the COVID-19 period, Black and Hispanic Veterans’ mean wait times exceeded those of White Veterans by 2.45 days for Black Veterans and 1.98 days for Hispanic Veterans.
  • There were only modest national disparities for cardiology services (<1-day difference).
  • There was variation in wait times across the 140 VA facilities. For example, pre-COVID, there were Black/White differences for cardiology at 6 facilities (Black Veterans waited longer at 4 facilities, White Veterans waited longer at 2 facilities). During COVID, 21 facilities had Black/White differences for cardiology (Black Veterans waited longer at 14 facilities, while White Veterans waited longer at 7 facilities).
  • Black and Hispanic Veterans were younger than White Veterans and more likely to reside in counties with a higher supply of physicians.

IMPLICATIONS:

  • Although differences in wait times were only a few days, any wait time disparity is concerning. It will be important for future work to monitor these trends, understand their sources, and implement appropriate interventions as needed. Findings also underscore the critical importance of facility-level analyses for highlighting opportunities to reduce disparities and target quality improvement efforts.

LIMITATIONS:

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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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