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New Study Documents Racial and Ethnic Disparities in Veterans’ Experiences With VA-Funded Community Care
Disparities Were Modest but Persisted
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In the past decade, Veterans Health Administration (VA) spending on community care more than doubled from approximately $8 billion in 2014 to over $18 billion in 2021. A recent study that I coauthored with colleagues from the federal VA Center for Health Equity Research and Promotion found Black and Hispanic Veterans experienced persistent disparities with this type of care, which is VA-funded but delivered outside of the VA health system by non-VA providers. Our results underscore a need for better administrative processes to help all Veterans navigate community care and for focused efforts to improve Black and Hispanic Veterans’ experiences with community care.
Deep-rooted racial and ethnic disparities are a well-documented problem in the United States, including in the VA. Over the last several decades, researchers have documented the extent of racial and ethnic disparities in U.S. Veterans’ access to care, experiences with care, and health outcomes within the VA health system.
However, there has been little research into health care inequities among Veterans who receive VA-funded care outside of the VA health system, even as more Veterans are receiving VA-funded care from outside providers. This trend was precipitated by major legislative changes in 2014 and 2018 that allowed Veterans to receive VA-funded “community care” if they could not obtain timely care within the VA or lived far from a VA health care facility.
We used national VA survey data to investigate racial and ethnic disparities in this setting, obtaining a sample of more than 230,000 Veterans who used VA-funded community care from 2016 to 2021. The survey assessed Veterans’ experiences with care in several areas, including overall ratings of community providers, satisfaction with provider communication, care coordination, navigating community care eligibility, scheduling appointments, and billing. We looked separately at how ratings of care differed by race (Veterans who identified as Black/African American vs. White) and ethnicity (Hispanic vs. non-Hispanic). We also explored whether disparities narrowed, widened, or stayed the same over the study period.
Four major findings stood out from our study:
- Compared to White and non-Hispanic Veterans, Black and Hispanic Veterans had worse ratings of community providers, provider communication, appointment scheduling, and billing.
- Furthermore, Hispanic Veterans also had worse ratings of care coordination compared to non-Hispanic Veterans. While the disparities were small, they were consistent across analyses, including when we looked at the probability of reporting very high or very low ratings of care.
- Veterans reported poor experiences with certain aspects of community care, including navigating eligibility and billing. In these areas, Black and Hispanic Veterans reported similar, or even sometimes better, experiences than White and non-Hispanic Veterans. However, poor overall experiences reported by Veterans in these areas underscored a need for improvements across the board.
- Racial and ethnic disparities persisted over our study period, however ratings improved overall from 2016 to 2021.
The findings highlight the persistent systemic bias and negative stereotypes that Black and Hispanic individuals face when seeking health care, whether or not they are Veterans, which have been found to impact the quality of care they receive and result in poor trust in the health care system. Our findings also highlight a need to improve VA administrative processes, including eligibility and billing in VA community care, where Veterans across racial and ethnic groups consistently reported worse experiences.
The results of our study echoes prior research that documented persistent racial and ethnic disparities in patient-provider trust and communication, influenced by a legacy of medical mistreatment of communities of color. High-quality, equitable care in the community is particularly important as many Veterans have complex care needs linked to the psychosocial and health impacts of military service.
Continued monitoring of Veterans’ experiences with community care is key for guiding policies to ensure that all Veterans have access to good care. Our work to identify these differences and understand how they drive the performance of VA community care is ongoing.
The study, “Racial and Ethnic Differences in Health Care Experiences for Veterans Receiving VA Community Care from 2016 to 2021,” appeared in the May 31, 2024 issue of the Journal of General Internal Medicine. Authors include Sudarshan Krishnamurthy, Yaming Li, Florentina Sileanu, Utibe R. Essien, Megan E. Vanneman, Maria Mor, Michael J. Fine, Carolyn T. Thorpe, Thomas Radomski, Katie Suda, Walid F. Gellad, and Eric T. Roberts.
Author
Eric T. Roberts, PhD
Associate Professor, General Internal Medicine, Perelman School of Medicine
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