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

CategorySelf-Reported Health Status
Excellent or Very GoodGoodFair or Poor
  • (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 […]”

  • (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.”

  • (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.”

  • (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.”

  • (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.