THE EFFECT OF DISTANCE TO VA FACILITIES ON THE CHOICE AND LEVEL OF UTILIZATION OF VA OUTPATIENT SERVICES

The 1987 survey of Veterans is used to explain the effects of distance to VA facilities on the choice and level of utilization of VA outpati ent services by U.S. veterans. A two part discrete continuous model is used to separate two elements of the decision to seek outpatient serv ices from federally operated VA facilities. First, a discrete choice i s made to seek care from the VA. Second, a continuous choice is made t o seek a particular level of utilization. Distance is found to affect the initial discrete choice significantly for measured distances up to 60 miles at a decreasing rate. Once some VA outpatient contact is mad e, distance is a major factor only for the elderly in determining the amount of utilization. Disturbingly, elderly veteran users living more than 30-40 miles from the nearest VA are expected to make fewer visit s in a year than younger veterans.