Equity in access for Veterans in the VA community care program

Abstract: The U.S. Department of Veterans Affairs (VA) has long been committed to providing quality, veterancentric care, a mission evolving through significant legislative efforts. The Choice Act of 2014 and the MISSION Act of 2018 were pivotal in expanding access to community-based care for veterans. By 2022, approximately 45% of veterans utilized these community care options. While these policies aimed to enhance care access, there are concerns about their potential to undermine VA-delivered health care and affect veteran health outcomes. Studies suggest that VA care often matches or exceeds the quality of community care. To evaluate the impact of these legislative changes on primary care utilization and wait times, Rosen and colleagues conducted a retrospective, observational study using data from the VA Corporate Data Warehouse for fiscal years 2021 and 2022. Analyzing data from over 5 million veterans and 4.6 million primary care consults, the study found an increase in primary care utilization across all groups. VA primary care had shorter wait times compared to community care. Racial and ethnic disparities were evident: Black and Hispanic veterans were less likely to use community care and faced longer wait times in certain settings compared to White veterans. The study's limitations include the lack of subjective measures of care access, the unexamined impact of telemedicine, and the absence of causal analysis between policy changes and care utilization. Despite these, the findings provide insights into how the Choice and MISSION Acts have influenced primary care access and utilization. Future research should employ quasi-experimental methods to better understand these policies' effects on care quality and equity for veterans.