Improving rural Veterans’ healthcare access through telehealth: Utilization patterns, cost savings, and transportation insecurity
Abstract:Rural veterans face persistent barriers to accessing timely and quality healthcare, with transportation insecurity emerging as a critical yet understudied challenge. In this dissertation, I present three studies exploring rural veterans’ use of telehealth and examining the factors contributing to transportation insecurity among this population. The first research examines the current evidence on Telehealth for Rural Veterans in the United States using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Three databases (Google Scholar, PubMed, and Scopus) were consulted to select relevant articles published from 2017 to 2023. Thirty-six articles met the inclusion criteria and were categorized into three research objectives: veterans’ medical conditions managed through telehealth (n = 24), veterans’ transportation cost savings using telehealth (n = 4), and telehealth use during the COVID-19 pandemic (n = 8). Results indicated that telehealth is a viable option for managing complex medical conditions like diabetes and cancer.The second paper conducts a cost-effectiveness analysis of telehealth to address transportation barriers among rural U.S. veterans. Using survey data from 226 veterans across 10 states, the study quantifies transportation-related savings averaging $767.36 annually per veteran and highlights improved access for disabled and low-income veterans. While telehealth reduced travel distances, time, and costs, older veterans and those with limited digital literacy continued to prefer in-person care, underscoring the need to address broadband and digital skill gaps for broader adoption.The third paper examines transportation insecurity among rural U.S. veterans, using a modified 19-item Transportation Security Index and survey data from 223 veterans across 10 states. Results reveal that 50% of veterans overall experience some level of transportation insecurity, with over 20% facing high insecurity. Vulnerable groups include low-income, disabled, younger, female, and minority veterans. Surprisingly, rural veterans reported slightly lower transportation insecurity than their metro and sub-metro peers, highlighting an area for future research.These studies provide a comprehensive analysis of telehealth adoption, the accessibility and efficiency benefits of telehealth, and transportation insecurity among rural U.S. veterans, offering practical insights for enhancing healthcare access and informing policy and program development.