VHA Policymakers May Need to Consider Additional Classification Schemes when Planning Care for “Rural” Veterans
Recently, VA established an Office of Rural Health to concentrate access and quality improvement efforts on the particular needs of rural Veterans for whom it may be necessary to travel longer distances to access VA healthcare services. To better understand the issues confronting Veterans living in rural settings, VHA developed a three-category classification system that designates locations throughout the U.S. as Urban, Rural, or Highly Rural. To understand the policy implications of the VA classification system, this study compared VA’s categories to three Office of Management and Budget (OMB) and four Rural-Urban Commuting Area (RUCA, developed by the University of Washington and the USDA) geographical categories. In particular, investigators assessed overlap of categories, implications for understanding whether VA travel time standards for patients are being met, and capacities for revealing regional variations. More than 8 million Veterans were included in the analyses.
- Although the three classification schemes differ considerably in the number of VHA healthcare enrollees designated as Rural residents, they all show that the proportions of rural Veterans among enrollees are substantial.
- VHA’s Rural category (36% of its enrollees) is broadly defined and includes up to 3 to 5 times the enrollees included in the middle RUCA or OMB categories. VHA’s Highly Rural and Urban categories are defined more narrowly than in the other schemes, suggesting that VHA’s categories may more accurately reflect specifically urban or remotely rural populations.
- Of Veterans enrolled in VA healthcare, roughly 1 in 60 is a Highly Rural resident. Under the VHA classification scheme, only half of Highly Rural VHA enrollees live within one hour of primary care; about 70% must travel more than two hours to get to acute care, and more than four hours to get to tertiary care.
- If policymakers rely solely on either the RUCA or OMB category scheme, they might conclude that access standards have been met for the majority of VHA enrollees. However, the VHA scheme indicates that access standards have not been met for Veterans living in highly rural settings. Thus, authors suggest that policymakers supplement analyses of Rural Veterans’ healthcare needs with more detailed breakdowns from other classification systems.
- Most of VHA’s Highly Rural enrollees live in the western U.S., where distances to care are great and alternative delivery systems may be needed.
Dr. West is an HSR&D investigator and is part of the VAMC in White River Junction, VT.
West A, Lee R, Shambaugh-Miller M, et al. Defining “Rural” for Veterans’ Health Care Planning. The Journal of Rural Health Fall 2010;26(4):301-309.