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“It’s Like Finding Your Way Through the Labyrinth”: a Qualitative Study of Veterans’ Experiences Accessing Healthcare

  • Original Research: Qualitative Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

The 2014 Veterans Choice Act and subsequent 2018 Veteran’s Affairs (VA) Maintaining Systems and Strengthening Integrated Outside Networks Act (MISSION Act) are legislation which clarified Veteran access to healthcare provided by non-VA clinicians (community care). These policies are of particular importance to Veterans living in rural areas, who tend to live farther from VA medical facilities than urban Veterans.

Objective

To understand Veterans’ experiences of the MISSION Act and how it impacted their access to primary care to inform future interventions with a focus on reaching rural Veterans.

Design

Qualitative descriptive design.

Participants

United States (US) Veterans in Northwestern states engaged in VA and/or community care.

Approach

Semi-structured interviews were conducted with a purposive sample of Veterans between August 2020 and September 2021. Interview domains focused on barriers and facilitators of healthcare access. Transcripts were analyzed using thematic analysis.

Key Results

We interviewed 28 Veterans; 52% utilized community care as their primary source of care and 36% were from rural or frontier areas. Three main themes emerged: (1) Veterans described their healthcare experiences as positive but also frustrating (billing and prior authorization were noted as top frustrations); (2) Veterans with medical complexities, living far from healthcare services, and/or seeking women’s healthcare services experienced additional frustration due to increased touch points with VA systems and processes; and (3) financial resources and/or knowledge of the VA system insulated Veterans from frustration with healthcare navigation.

Conclusions

Despite provisions in the MISSION Act, Veteran participants described persistent barriers to healthcare access. Patient characteristics that required increased interaction with VA processes exacerbated these barriers, while financial resources and VA system knowledge mitigated them. Interventions to improve care coordination or address access barriers across VA and community care settings could improve access and reduce health inequities for Veterans—especially those with medical complexities, those living far from healthcare services, or those seeking women’s healthcare.

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Data Availability:

The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.

References

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Acknowledgements:

Contributors: We appreciate Veterans who participated in this study. We thank Jack Lazar for conducting interviews and Will Moore for providing his perspective during data analysis. We appreciate Alex Moore for their contributions to the drafting, editing, and submission support for this manuscript.

Funding

Funding for this research was provided by the U.S. Department of Veterans Affairs (VA) Office of Rural Health. The views expressed in this manuscript are those of the authors and do not necessarily reflect the views of the VA or the US government. Visit www.ruralhealth.va.gov to learn more.

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Authors and Affiliations

  1. Oregon Rural Practice Based Research Network, Portland, USA

    NithyaPriya S. Ramalingam PhD, Chrystal Barnes BS, Mary Patzel MBA & Melinda M. Davis PhD, MCR

  2. Oregon Health & Science University, Portland, USA

    NithyaPriya S. Ramalingam PhD, Chrystal Barnes BS, Mary Patzel MBA, Erin S. Kenzie PhD & Melinda M. Davis PhD, MCR

  3. OHSU-PSU School of Public Health, Portland, USA

    Erin S. Kenzie PhD

  4. Veterans Rural Health Resource Center-Portland, VA Portland Health Care System, Portland, USA

    Sarah S. Ono PhD

  5. Department of Veterans Affairs Office of Rural Health, Washington, D.C, USA

    Sarah S. Ono PhD

  6. Department of Psychiatry, Oregon Health & Science University, Portland, USA

    Sarah S. Ono PhD

  7. Department of Family Medicine and OHSU-PSU School of Public Health, Portland, USA

    Melinda M. Davis PhD, MCR

  8. Oregon Clinical and Translational Research Institute, Portland, USA

    Melinda M. Davis PhD, MCR

Authors
  1. NithyaPriya S. Ramalingam PhD
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  2. Chrystal Barnes BS
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  3. Mary Patzel MBA
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  4. Erin S. Kenzie PhD
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Correspondence to Mary Patzel MBA.

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Ramalingam, N.S., Barnes, C., Patzel, M. et al. “It’s Like Finding Your Way Through the Labyrinth”: a Qualitative Study of Veterans’ Experiences Accessing Healthcare. J GEN INTERN MED 39, 596–602 (2024). https://doi.org/10.1007/s11606-023-08442-7

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  • DOI: https://doi.org/10.1007/s11606-023-08442-7

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