title: To use or not to use. What influences why women veterans choose VA health care.
abstract: OBJECTIVE
  Effects of advances in Department of Veterans Affairs (VA) women's health care on women veterans' health care decision making are unknown. Our objective was to determine why women veterans use or do not use VA health care.
  
  
  METHODS
  Cross-sectional survey of 2,174 women veteran VA users and VA-eligible nonusers throughout southern California and southern Nevada.
  
  
  METHODS
  VA utilization, attitudes toward care, and socio-demographics.
  
  
  RESULTS
  Reasons cited for VA use included affordability (67.9%); women's health clinic (WHC) availability (58.8%); quality of care (54.8%); and convenience (47.9%). Reasons for choosing health care in non-VA settings included having insurance (71.0%); greater convenience of non-VA care (66.9%); lack of knowledge of VA eligibility and services (48.5%); and perceived better non-VA quality (34.5%). After adjustment for socio-demographics, health characteristics, and VA priority group, knowledge deficits about VA eligibility and services and perceived worse VA care quality predicted outside health care use. VA users were less likely than non-VA users to have after-hours access to nonemergency care, but more likely to receive both general and gender-related care from the same clinic or provider, to use a WHC for gender-related care, and to consider WHC availability very important.
  
  
  CONCLUSIONS
  Lack of information about VA, perceptions of VA quality, and inconvenience of VA care, are deterrents to VA use for many women veterans. VA WHCs may foster VA use. Educational campaigns are needed to fill the knowledge gap regarding women veterans' VA eligibility and advances in VA quality of care, while VA managers consider solutions to after-hours access barriers.
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. donna.washington@va.gov
authors.forename: Donna L
authors.initials: DL
authors.lastname: Washington
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Barbara
authors.initials: B
authors.lastname: Simon
authors.forename: Su
authors.initials: S
authors.lastname: Sun
mesh_terms: D002755:Choice Behavior; D003695:Delivery of Health Care / Q000592:standards / Q000639:trends*; D005260:Female; D006801:Humans; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards*; D014728:Veterans / Q000706:statistics & numerical data*; D014930:Women