title: Access to care for women veterans: delayed healthcare and unmet need.
abstract: BACKGROUND
  Timely access to healthcare is essential to ensuring optimal health outcomes, and not surprisingly, is at the heart of healthcare reform efforts. While the Veterans Health Administration (VA) has made improved access a priority, women veterans still underutilize VA healthcare relative to men. Eliminating access disparities requires a better understanding of the barriers to care that women veterans' experience.
  
  
  OBJECTIVE
  We examined the association of general and veteran-specific barriers on access to healthcare among women veterans.
  
  
  METHODS
  Cross-sectional, population-based national telephone survey of 3,611 women veterans.
  
  
  METHODS
  Delayed healthcare or unmet healthcare need in the prior 12 months.
  
  
  RESULTS
  Of women veterans, 19% had delayed healthcare or unmet need, with higher rates in younger age groups (36%, 29%, 16%, 7%, respectively, in 18-34, 35-49, 50-64, and 65-plus age groups; p < 0.001). Among those delaying or going without care, barriers that varied by age group were: unaffordable healthcare (63% of 18-34 versus 12% of 65-plus age groups); inability to take off from work (39% of those <50); and transportation difficulties (36% of 65-plus). Controlling for age, race/ethnicity, regular source of care, and health status, being uninsured (OR = 6.5; confidence interval [CI] 3.0-14.0), knowledge gaps about VA care (OR = 2.1; 95% CI 1.1-4.0), perception that VA providers are not gender-sensitive (OR = 2.4; CI 1.2-4.7), and military sexual assault history (OR = 2.1; CI 1.1-4.0) predicted delaying or foregoing care, whereas VA use and enrollment priority did not.
  
  
  CONCLUSIONS
  Both general and veteran-specific factors impact women veterans' access to needed services. Many of the identified access barriers are potentially modifiable through expanded VA healthcare and social services. Health reform efforts should address these barriers for VA nonusers. Efforts are also warranted to improve women veterans' knowledge of availability and affordability of VA healthcare, and to enhance the gender-sensitivity of this care.
authors: VA Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence, Sepulveda, CA, USA. donna.washington@va.gov
authors: Donna L
authors: DL
authors: Washington
authors: Bevanne
authors: B
authors: Bean-Mayberry
authors: Deborah
authors: D
authors: Riopelle
authors: Elizabeth M
authors: EM
authors: Yano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health / Q000592:standards*; D016387:Women's Health / Q000592:standards*