Is travel distance a barrier to veterans' use of VA hospitals for medical surgical care?

Lengthy travel distances may explain why relatively few veterans in the Uni ted States use VG hospitals for inpatient medical/surgical care. We used tw o approaches to distinguish the effect of distance on VA use from other fac tors such as access to alternatives and veterans' characteristics. The firs t approach describes how disparities in travel distance to the VA are relat ed to other characteristics of geographic areas. The second approach involv ed a multivariate analysis of VA use in postal zip code areas (ZCAs), We us ed several sources of data to estimate the number of veterans who had prior ity access to the VA so that use rates could be estimated. Access to hospit als was characterized by estimated travel distance to inpatient providers t hat typically serve each ZCA. The results demonstrate that travel distance to the VA is variable, with veterans in rural areas traveling much farther for VA care than veterans in areas of high population density. However, Med icare recipients also travel farther in areas of low population density. In some areas veterans must travel lengthy distances for VA care because VA h ospitals which were built over the past few decades are not located close t o areas in which veterans reside in the 1990s. The disparities in travel di stance suggest inequitable access to the VA. Use of the VA decreases with i ncreases in travel distance only up to about 15 miles, after which use is r elatively insensitive to further increases in distance, The multivariate an alyses indicate that those over 65 are less sensitive to distance than youn ger veterans, even though those over 65 are Medicare eligible and therefore have inexpensive access to alternatives. The results suggest that proximit y to a VA hospital is only one of many factors determining VA use, Further research is indicated to develop an appropriate response to the needs of th e small but apparently dedicated group of VA users who are traveling very l ong distances to obtain VA care. (C) 2000 Elsevier Science Ltd. All rights reserved.