Healthcare needs and factors related to non-use/underutilization of Veterans Healthcare Administration (VHA) health services entitlements by post 9/11 women veterans

Abstract

<p>Women are the fastest growing population in the Department of Veteran Affairs (VA), but only in recent history. U.S. military shift to an All-Volunteer Force (AVF) in 1973 resulted in a dramatic spike in women serving in the military. During the transition from active military to Veteran status, Veterans are eligible to apply to the Department of Veterans Affairs (VA) for benefits, including healthcare. In 2020, the VA estimated that over two million Women Veterans (WV) were living. The VA estimates the percentage of WV will rise to over 18% of all Veterans by 2046. In a report to Congress in FY2020, 38.8% of eligible WV were enrolled in Veterans Health Administration (VHA) services, but only 22.4% used VHA services in the prior 12 months. It has been reported that many WV cite feeling unwelcome in VHA while others question the adequacy of gender-based services. The purpose of this study was to gain a better understanding of VHA health services use patterns and factors influencing non-use/underutilization by two current<br />service era populations of WV. This study used a quantitative, secondary analysis of two WV cohorts: 158 Pre 9/11 and 124 Post 9/11 WV from the National Survey of Veterans 2010 (NSV 2010). The analysis included nonparametric tests for differences between groups for three outcome variables: enrollment for VHA care, use of primary care within the prior six months, and use of women&rsquo;s healthcare within the prior twelve months. Binary logistic regressions were performed to determine the significance of predictor variables developed under the Behavioral Model of Health Services Use by Andersen. Findings: Percentages of non-enrolled in the Pre 9/11 and Post 9/11 WV groups were 53.15% and 45.97%, respectively. Within the prior year, 77.20% of Pre 9/11 WV used primary healthcare services and 65.60% used women&rsquo;s healthcare services that were not in or paid for by the VHA. Similarly, 74.20% of Post 9/11 WV used primary healthcare services and 63.70% used women&rsquo;s healthcare services that were not in or paid for by the VHA. An unanticipated finding was WV in the two service era groups who used outpatient care outside the VHA system in the prior six months, 35.66% Pre 9/11 and 41.30% Post 9/11 paid for healthcare services out-of-pocket. Directing research and programs to target WV who are not enrolled for VHA health services can guide VHA efforts to tailor outreach to improve access and use of entitled healthcare services within the VHA these WV have earned.</p>