Women veterans are less healthy than their nonveteran female counterparts and are in poorer emotional health relative to male veterans.1–3
Moreover, women veterans report experiencing stressful and traumatic events at a higher rate than either nonveteran women or male veterans,3, 4
and these exposures have well-established consequences for mental and physical health.3–6
Thus, access to high-quality health care is especially important for women veterans.
Although historically serving primarily male veterans, women are a growing proportion of the patients seeking Veterans Health Administration (VHA) care.1, 7, 8
The VHA offers a full continuum of comprehensive medical services, as well as a number of gender-specific services, to eligible women veterans.7, 9, 10
However, accumulating evidence points to a number of problems with women veterans' access to and use of VHA health care.8, 11, 12
In addition, there is some evidence that women underutilize VHA care relative to men.7
This may be at least partially explained by the finding that women veterans perceive or experience a number of barriers to VHA care.2, 8, 11, 13, 14
Although the literature upon which these findings are based is informative, the majority of studies of barriers to VHA care have been conducted on convenience samples and cannot speak to general trends within the broader population of women veterans.2, 15–17
Thus, the primary goal of the current study was to document perceived and/or actual barriers to care in a nationally representative sample of women veterans who have accessed VHA care and examine associations between barriers to care and VHA use.
Although specific guidelines have evolved over time, in general, veterans with service-connected disabilities are considered higher priority patients at the VHA.18, 19
Whereas there is some evidence that service-connected disability status is a positive predictor of VHA use,20
one might expect that women with service-connected disabilities would perceive more barriers to care and barriers to care might be a stronger predictor of VHA use for women with service-connected disabilities.21, 22
Thus, a secondary goal of this study was to examine the extent to which barriers to care differ and differentially influence VHA use for women with and without service-connected disabilities.
Historically, barriers to care have been categorized as either individual/personal or structural/institutional in nature.20
Investigators who have examined individual/personal barriers to care have focused on characteristics such as socioeconomic status, gender, patient age, and disease status.20
One study that examined a number of potential individual/personal predictors found that women who were current VHA users were less likely to be ethnic minorities, had fewer children, had served more time in the military, had lower rates of insurance coverage, poorer health, more posttraumatic stress symptomatology, greater exposure to combat and assault, and were more likely to have a service-connected disability compared with former users.23
Other investigators have considered structural/institutional factors that may serve as barriers to care, such as the availability of services, health care provider characteristics, and logistics of care.20, 24, 25
Findings indicate that structural/institutional barriers can substantially influence use of services and subsequent clinical outcomes.20, 24–26
A number of structural/institutional barriers to care may be especially relevant for women veterans. One potential barrier relates to the perceived and/or actual availability of health care services,20
particularly the availability of women-specific services.3, 13
Access to care is not uniform across VHA facilities, with some facilities providing separate women's health clinics and some facilities integrating women's health care into the larger system.4
Another potential barrier to VHA care may be a perceived lack of sensitivity or skill among VHA staff with respect to women's unique health care needs. Perhaps in part due to the fact that the VHA has historically provided care to men, some staff may not be optimally sensitive or knowledgeable regarding aspects of women's health care.4, 12, 14, 27, 28
A final barrier that is likely to be salient for both women and men veterans relates to the ease of using VHA health care, both with regard to the logistical factors of receiving needed care,20, 29
and the accessibility of VHA facilities and aspects of the physical environment.11, 30
In summary, the primary goal of the present study was to document perceived and/or actual barriers to care in a nationally representative sample of women veterans who had accessed VHA care and examine associations between barriers to care and VHA use. A secondary goal was to examine the extent to which barriers to care and their associations with VHA use differ for women with and without service-connected disabilities. We benefited from having a large, nationally representative sample and sample design weights to facilitate generalization to the population of women veterans.