Enrollment in VA Healthcare Most Likely in First Year after Return from Deployment for Army Reserve/National Guard Members
Among those deployed to Iraq and Afghanistan as of 2010, Reserve Components (RC), specifically Army National Guard (ARNG) and Army Reservists (AR), comprise almost 44% of Army deployments. Upon return from deployment, RC members go through a required demobilization process designed to ensure that they get the healthcare services they need. Further, the National Defense Authorization Act of 2008 entitles all combat Veterans who meet minimum duty requirements, including those in the RC, up to five years of at least VHA Priority Group 6 status. This includes full access to VA's medical benefits package – and free VA services for conditions potentially related to service in a war zone. This study examines rates and predictors of RC members' enrollment and use of VA healthcare services through this entitlement in the first year following demobilization from an index deployment. Investigators also assessed regional and VA facility variation in serving eligible members in their catchment areas. Investigators identified 125,434 ARNG and 48,423 AR members who had been deployed to OEF/OIF countries, and who had demobilized following an index deployment end date between FY08 and FY11.
- Of the Veterans in this study, 57% of Army National Guard members and 46% of Army Reserve members used VA care within 12 months of demobilization, suggesting that Reserve Component members are most likely to enroll in VA healthcare in the year following return from deployment.
- The percent of ARNG and AR members in each VA facility's catchment area who received VA healthcare as an enrollee varied substantially – from as low as 25% to more than 85%, even after adjusting for driving time, demographics, and service-related factors. Investigators suggest that future research and QI efforts with VA and DoD should strive to better understand this variation and the extent to which it is explained by factors such as the availability of non-VA healthcare options, actual or perceived quality of VA care, and/or availability of education and outreach interventions.
- The only factor with substantially different predictive value between samples was receiving pre-index services as a VA healthcare enrollee, presumably related to a previous deployment.
- Female members were more likely to enroll in VA healthcare than male members, an important finding given that women are the fastest growing segment of the Veteran population.
- Investigators did not account for other indicators of deployment-related medical needs.
- The construction of VA healthcare catchment areas based on median drive times between 3-digit zip codes was ad hoc and had not been validated.
Dr. Harris is Director of VA/HSR&D's Substance Use Disorder Quality Enhancement Research Initiative (SUD-QUERI). Drs. Harris and Chen are part of HSR&D's Center for Innovation to Implementation: Fostering High Value Care located in Palo Alto, CA.
Harris A, Chen C, Mohr B, et al. Predictors of Army National Guard and Reserve Members Use of Veteran Health Administration Health Care after Demobilizing from OEF/OIF Deployment. Military Medicine. October 2014;179(10):1090-98.