Article Figures & Data
Figures
- Figure 1.
Percentage of patients mentioning the categories of Acceptability, Accessibility, Affordability, Availability and Accommodation as reasons for using Veterans Affairs and non-Veterans Affairs services across self-reported health status. Self-reported health status categorized as excellent/very good (black bars), good (gray bars), and fair/poor (white bars). *P < .05
Tables
- Table 1.
Population Characteristics of Respondents to Survey From March 2016 to August 2017 Stratified by Self-Reported Health Status
Total Self-Reported Health Excellent or Very Good Good Fair or Poor P value N 166 41 71 54 % 24.7 42.8 32.5 Age categories (%) 65 to 74 years 38.6 41.5 33.8 42.6 .094 75 to 84 years 39.2 48.8 42.3 27.8 85 years and older 22.3 9.8 23.9 29.6 Race/ethnicity (%) NH white 32.5 26.8 45.1 20.4 .008 NH black 34.9 34.1 36.6 33.3 Hispanic 27.1 31.7 12.7 42.6 NH Other 5.4 7.3 5.6 3.7 Language at home (%) English only 78.2 75.0 90.1 64.8 .003 Education (%) <High School 16.3 19.5 18.3 11.1 .825 High school graduate/GED 36.7 31.7 35.2 42.6 Some college 33.1 31.7 32.4 35.2 4-year degree or more 13.9 17.1 14.1 11.1 Health literacy, inadequate 34.3 26.8 29.6 46.3 .076 Income (%) <$25,000 51.2 51.2 54.9 46.3 .594 $25,001 to 50,000 22.9 26.8 15.5 29.6 >$50,000 18.1 14.6 19.7 18.5 Income, unknown 7.8 7.3 9.9 5.6 Married (%) 41.0 48.8 33.8 44.4 .245 Household size, mean ± SD 1.9 (0.9) 1.8 (0.7) 1.9 (0.9) 2.0 (1.1) .494 Cognitive status Any impairment (%) 4.9 2.4 4.2 7.6 .494 Functional impairment (%) ADL impairment 23.5 14.6 21.1 33.3 .085 IADL impairment 40.4 24.4 36.6 57.4 .004 Assistance device use (%) Independent, inside 71.1 78.0 69.0 68.5 .525 Independent, outside 45.8 63.4 39.4 40.7 .033 Insurance (%) Medicare 88.0 87.8 91.5 83.3 .376 Medicaid 19.3 26.8 19.7 13.0 .235 Other insurance 54.2 48.8 59.2 51.9 .520 Source(s) of care (%) Non-VHA provider 62.0 65.9 63.4 57.4 .670 Most of care VHA 78.3 85.4 73.2 79.6 .207 Non-VHA 21.1 12.2 26.8 20.4 Unknown 0.6 2.4 0.0 0.0 Travel to clinic Drive (%) 53.0 51.2 52.1 55.6 .898 Travel time, minutes ± SD 33.3 ± 21.3 37.4 ± 15.0 33.9 ± 24.3 29.5 ± 17.4 .328 ALD, Activities of Daily Living; GED, general education degree, IADL, Independent Activities of Daily Living; NH, Non-Hispanic, SD, standard deviation; VHA, Veterans Health Administration.
*P < .05.
- Appendix Table 1:
Exemplar Responses From Veterans for Using Veterans Affairs and Non-Veterans Affairs Care Across 5 Dimensions of Access Stratified by Self-Reported Health Status
Category Self-Reported Health Status Excellent or Very Good Good Fair or Poor Acceptability (Satisfaction) “Only because cardiologist, non-VHA put in my pacemaker. He knows me well; he saved my life. I feel comfortable with his care.”
(Relationship) “I've been in the VHA for 40 years.”
(Satisfaction) “I had a MI, brought to the Hospital, kept the Cardiologist since then because he more or less saved my life.”
(Relationship) “I've had non-VHA PCP for at least 20 years, and I like him.”
(Satisfaction) “[I] went to [outside hospital]. EMS took me there. I had a heart attack […] She is very efficient […]. I stayed with her care. She kept me under control.”
(Relationship) “My non-VHA PCP has been my doctor for 40 years […]”
Accessibility (Proximity) “If I can't make it to the VHA, the non-VHA is closer. Go to non-VHA for minor things”
(Travel burden) “Convenience, location. Aging, I drive but maybe my car isn't safe, and I don't intend to replace it, so transportation will be in question.”
(Proximity) “Having assurance of having someone close if something happens…”
(Proximity for emergent care) “If something is wrong, I will come here but EMS would have to bring me to the nearest hospital”
(Proximity) “The non-VHA doctor and hospital is 3 blocks from my house. It's very close. He is a good doctor.”
(Travel burden) “Traveling is main reason. I can't handle it anymore.”
Affordability (VHA Benefits) “Because I served, the VHA is more convenient. I have no insurance except Medicare.”
(Out-pocket costs) “Starting to come here [VHA] now because of the payments.”
(Costs, out-of-pocket) “There are no payments here [VHA]. On the outside, it costs me. My medications are free here […].”
(Costs) “Prefer VHA now especially because cost increasing outside as I get older.”
(Costs, Medications) “Medications cost too much so I will start coming here to the VHA”
(Costs, Medications) “Now the specialists and the medicine are free at the VHA.”
Availability (Specialty services) “Chiropractor is non-VHA because can't get one here at the VHA and can't get a referral for the chiropractor here. Also, Dental is non-VHA because can't get one here.”
(Choice of services) “I have a vast array of choices for providers and services at non-VHA”
(Specific services) “I use the VHA for specific reasons like optometry and service-related benefits.”
Accommodation (Wait-time) “Because I have the insurance I use outside doctor, I know it gets busy in here. I let the other guys use the VHA.”
(Wait-time) “I can get an immediate appointment with my non-VHA primary.”
(Wait-time) “After finding out I had cancer, VHA would make me wait 2 weeks for MRI so contacted my pulmonologist and went to [non-VHA hospital].”
(One stop shop) “Everything is cohesive as far as the specialty doctors being all here”
(Wait-time) “Non-VHA for quicker treatment and emergencies”
VHA, Veterans Health Administration; MRI, magnetic resonance imaging; PCP, primary care physician; EMS, emergency medical services.
- Appendix Table 2:
Characteristics of Participants of Minority Race and Ethnicity Across Self-Reported Health Status
Total Self-Reported Health Excellent or Very Good Good Fair or Poor P value N 112 30 39 43 % 26.8 34.8 38.4 Age categories (%) 65 to 74 years 43.8 46.7 43.6 41.9 .276 75 to 84 years 35.7 43.3 38.5 27.9 85 years and older 20.5 10.0 17.9 30.2 Race/ethnicity (%) NH black 51.8 46.7 66.7 41.9 .077 Hispanic 40.2 43.3 23.1 53.5 Other 8.0 10.0 10.3 4.7 Language at home (%) English only 70.3 65.5 87.2 58.1 .013* Education (%) <High School 17.9 23.3 17.9 14.0 .860 High school graduate/GED 41.1 36.7 41.0 44.2 Some college 29.5 23.3 30.8 32.6 4-year degree or more 11.6 16.7 10.3 9.3 Health literacy, inadequate 37.5 26.7 38.5 44.2 .311 Income (%) <$25 000 55.4 56.7 59.0 51.2 .547 $25 001 to 50 000 20.5 20.0 15.4 25.6 >$50 000 19.6 13.3 23.1 20.9 Income, unknown 4.5 10.0 2.6 2.3 Married (%) 44.6 53.3 35.9 46.5 .335 Household size, mean ± SD 2.0 ± 0.9 1.9 ± 0.7 1.9 ± 0.88 2.1 ± 1.1 .533 Cognitive status Any impairment (%) 4.5 3.3 2.6 7.0 .590 Functional impairment (%) ADL impairment 20.5 13.3 20.5 25.6 .444 IADL impairment 39.3 20.0 35.9 55.8 .007 Assistance device use (%) Independent, inside 70.5 76.7 71.8 65.1 .554 Independent, outside 48.2 60.0 51.3 37.2 .142 Insurance (%) Medicare 83.9 86.7 87.2 79.1 .542 Medicaid 24.1 36.7 28.2 11.6 .037* Other insurance 51.8 53.3 53.8 48.8 .885 Source(s) of care (%) Non-VHA provider 55.4 60.0 56.4 51.2 .746 Most of care VHA 84.8 86.7 76.9 90.7 .210 Non-VHA 15.2 13.3 23.1 9.3 Unknown 0.0 0.0 0.0 0.0 Travel to clinic Drive (%) 49.1 50.0 46.2 51.2 .897 Travel time, minutes ± SD 35 ± 22 39 ± 10 36 ± 26 31 ± 18 .381 ALD, Activities of Daily Living; GED, general education degree; IADL, Independent Activities of Daily Living; NH, Non-Hispanic; SD, standard deviation; VHA, Veterans Health Administration.
↵* P < .05.
- Appendix Table 3:
Characteristics of Non-Hispanic White Participants Across Self-Reported Health Status
Total Self-Reported Health Excellent or Very Good Good Fair or Poor P value N 54 11 32 11 % 20.4 59.3 20.4 Age categories (%) 65 to 74 years 27.8 27.3 21.9 45.5 .522 75 to 84 years 46.3 63.6 46.9 27.3 85 years and older 25.9 9.1 31.3 27.3 Race/ethnicity (%) NH white 100.0 NA NA NA Language at home (%) English only 94.4 100.0 93.8 90.9 .625 Education (%) <High School 13.0 9.1 18.8 0.0 .686 High school graduate/GED 27.8 18.2 28.1 36.4 Some college 40.7 54.5 34.4 45.5 4-year degree or more 18.5 18.2 18.8 18.2 Health literacy, inadequate 27.8 27.3 18.8 54.5 Income (%) <$25 000 42.6 36.4 50.0 27.3 .262 $25 001 to 50 000 27.8 45.5 15.6 45.5 >$50 000 14.8 18.2 15.6 9.1 Income, unknown 14.8 0.0 18.8 18.2 Married (%) 33.3 36.4 31.3 36.4 .926 Household size, mean ± SD 1.7 ± 0.9 1.5 ± 0.5 1.8 ± 1.0 1.7 ± 0.8 .468 Cognitive status Any impairment (%) 5.7 0.0 6.3 10.0 .596 Functional impairment (%) ADL impairment 29.6 18.2 21.9 63.6 .021* IADL impairment 42.6 36.4 37.5 63.6 .286 Assistance device use (%) Independent, inside 72.2 81.8 65.6 81.8 .427 Independent, outside 40.7 72.7 25.0 54.5 .012* Insurance (%) Medicare 96.3 90.9 96.9 100.0 .510 Medicaid 9.3 0.0 9.4 18.2 .339 Other insurance 59.3 36.4 65.6 63.6 .222 Source(s) of care (%) Non-VHA provider 75.9 81.8 71.9 81.8 .703 Most of care VHA 64.8 81.8 68.8 36.4 .030* Non-VHA 33.3 9.1 31.3 63.6 Unknown 1.9 9.1 0.0 0.0 Travel to clinic Drive (%) 61.1 54.5 59.4 72.7 .649 Travel time, minutes ± SD 30 ± 20 36 ± 15 32 ± 22 22 ± 12 .283 ALD, Activities of Daily Living; GED, general education degree, IADL, Independent Activities of Daily Living; NA, not applicable; NH, Non-Hispanic, SD, standard deviation; VHA, Veterans Health Administration.
↵* P < .05.
- Appendix Table 4:
Categories of Reasons for Veteran Affairs and Non-Veteran Health Administration Use Across Self-Reported Health Status for Non-Hispanic White Respondents and Respondents of Other Races and Ethnicities
Total Excellent or Very Good Good Fair or Poor P value NH-white, N (%) 54 11 (20) 32 (59) 11 (20) Other, N (%) 112 30 (27) 39 (35) 43 (38) Acceptability (%) NH-white 55.6 54.5 50.0 72.7 .424 Other 34.8 46.7 33.3 27.9 .247 Accessibility (%) NH-white 37.0 54.5 31.3 36.4 .385 Other* 37.5 13.3* 43.6* 48.8* .005* Affordability (%) NH-white 25.9 18.2 34.4 9.1 .206 Other 36.6 40.0 41.0 30.2 .541 Availability (%) NH-white 27.8 54.5 18.8 27.3 .073 Other 23.2 20.0 28.2 20.9 .656 Accommodation (%) NH-white 11.1 9.1 12.5 9.1 .926 Other 10.7 3.3 12.8 14.0 .307 NH, Non-Hispanic.
↵* P < .05.
