title: The effect of increased travel reimbursement rates on health care utilization in the VA.
abstract: OBJECTIVE
  The reimbursement rate that eligible veterans receive for travel to Department of Veterans Affairs (VA) facilities increased from 11 to 28.5 cents per mile on February 1, 2008. We examined the effect of this policy change on utilization of outpatient, inpatient, and pharmacy services, stratifying veterans based on distance from a VA facility.
  
  
  METHODS
  We compared health care utilization and costs on a sample of VA patients in the 10.5 months before the reimbursement rate increase and the 10.5 months after the reimbursement rate increase. Using a difference-in-difference technique, we ran multivariable logistic and count regressions for utilization and generalized linear models (GLM) for cost outcomes. Regressions were stratified based on urban and rural residence, as well as by distance thresholds.
  
  
  RESULTS
  Our cohort contained 250,958 veterans, 76.7% (n = 192,559) of whom were eligible to receive a travel reimbursement. After the reimbursement rate increase, eligible veterans at all distances were 6.8% more likely to have an outpatient encounter and had 2.6% more outpatient encounters in the VA compared to those not eligible for the reimbursement (P< .001). Similar results were found for prescription fills at all distances, but inpatient encounters remained generally unaffected.
  
  
  CONCLUSIONS
  Our results suggest that this policy change was successful in increasing access to VA care for patients regardless of location of residence.
authors.affiliation: Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah 84148, USA. Richard.Nelson@utah.edu
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
authors.forename: Bret
authors.initials: B
authors.lastname: Hicken
authors.forename: Alan
authors.initials: A
authors.lastname: West
authors.forename: Randall
authors.initials: R
authors.lastname: Rupper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics*; D014505:Urban Population