Veterans' system-of-care preferences for percutaneous transluminal coronary angioplasty in a rural setting.
BACKGROUND
In the Veterans Health Administration (VHA), regionalization of high-technology health care services may influence veterans who live far from referral centers to obtain care locally, through the private sector.


OBJECTIVE
To understand veterans' system-of-care preferences for a high-technology regionalized service.


METHODS
The charts of 142 veterans who were referred for percutaneous transluminal coronary angioplasty (PTCA) by their VHA cardiologists were reviewed.


RESULTS
Fifty-two percent of these veterans obtained the procedure outside the VHA system. Insurance coverage and out-of-pocket costs were strongly associated with veterans' obtaining PTCA outside of the VHA system; travel distance was not.


CONCLUSIONS
As the VHA begins to understand veterans' use of multiple systems of care, it will be important to understand the relationship between out-of-pocket costs and the system of care used for high-technology health care services.
Weeks
William B
WB
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire, USA. william.b.weeks@dartmouth.edu
O'Rourke
Daniel J
DJ
Ryder
Lisa B
LB
Straw
Michelle M
MM
D000800:Angioplasty, Balloon / Q000191:economics / Q000706:statistics & numerical data*; D005382:Financing, Personal; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017149:Private Sector / Q000191:economics / Q000706:statistics & numerical data*; D012040:Regional Health Planning / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D014707:Vermont