title: Utilization of travel reimbursement in the Veterans Health Administration.
abstract: OBJECTIVE
  To improve access to care, the Veterans Health Administration (VHA) increased its patient travel reimbursement rate from 11 to 28.5 cents per mile on February 1, 2008, and again to 41.5 cents per mile on November 17, 2008. We identified characteristics of veterans more likely to receive travel reimbursements and evaluated the impact of these increases on utilization of the benefit.
  
  
  METHODS
  We examined the likelihood of receiving any reimbursement, number of reimbursements, and dollar amount of reimbursements for VHA patients before and after both reimbursement rate increases. Because of our data's longitudinal nature, we used multivariable generalized estimating equation models for analysis. Rurality and categorical distance from the nearest VHA facility were examined in separate regressions.
  
  
  RESULTS
  Our cohort contained 214,376 veterans. During the study period, the average number of reimbursements per veteran was higher for rural patients compared to urban patients, and for those living 50-75 miles from the nearest VHA facility compared to those living closer. Higher reimbursement rates led to more veterans obtaining reimbursement regardless of urban-rural residence or distance traveled to the nearest VHA facility. However, after the rate increases, urban veterans and veterans living <50 miles from the nearest VHA facility increased their travel reimbursement utilization slightly more than other patients.
  
  
  CONCLUSIONS
  Our findings suggest an inverted U-shaped relationship between veterans' utilization of the VHA travel reimbursement benefit and travel distance. Both urban and rural veterans responded in roughly equal manner to changes to this benefit.
authors.affiliation: Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
authors.forename: Bret
authors.initials: B
authors.lastname: Hicken
authors.forename: Beilei
authors.initials: B
authors.lastname: Cai
authors.forename: Arati
authors.initials: A
authors.lastname: Dahal
authors.forename: Alan
authors.initials: A
authors.lastname: West
authors.forename: Randall
authors.initials: R
authors.lastname: Rupper
mesh_terms: D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D012424:Rural Population; D014195:Travel; D014481:United States; D014493:United States Department of Veterans Affairs; D014505:Urban Population; D014728:Veterans
keywords: access to care; program evaluation; rural; travel reimbursement; veterans