Gender, Race, and Veteran Health Care Utilization

Background/Purpose: The United States Department of Veterans Affairs (VA) oversees the largest integrated health care system in the nation, serving an estimated 8.76 million veterans across its 1,700 sites.  However, service provision within the VA has traditionally been skewed toward the needs of male veterans.  This trend is concerning given that research on women veterans has documented high rates of military sexual trauma, depression, anxiety, substance use disorders, and posttraumatic stress disorder.  Yet, an estimated 87% of female veterans do not use any VA health care services due to concerns over the lack of gender-specific care and limited information on benefits.  Previous research on VA health care utilization has also suggested that service access is not equitable across all racial/ethnic groups.  Low-income African American and Hispanic male veterans tend to utilize the VA as their primary source of care due to its affordability.  Studies have not typically considered how gender interacts with this relationship.  The purpose of the present study is to explore the moderating effects of gender on race and health care utilization within the VA system.

Methods: Data from the 2010 National Survey of Veterans (N=8,710) were analyzed to assess the moderating effects of gender on race and veteran health care access.  Binary logistic regression models were run with and without interactions to estimate the relationship between demographic variables (gender, race, age, health status, combat service, exposure to death and dying, number of dependents, marriage, employment status) and whether or not veterans had ever enrolled in VA health care, utilized VA health care services, or used any outpatient mental health or substance abuse services in the last six months.  Post-estimation tests were run to determine goodness of fit before running final models with weighted estimates. 

Results: Although none of the interaction models improved upon the main-effects models, one interaction effect was significant.  Relative to all other female veterans, Hispanic females had decreased odds of having ever used VA health care (OR = .42; 95% CI=.19, .95; p < .05).  This finding emerged in contrast to outcomes from the main-effects models, where women had significantly increased odds of ever enrolling or using VA health care compared to male veterans. Moreover, women had just over twice (OR = 2.09; 95% CI=1.41, 3.08; p < .001) the odds of accessing any outpatient mental health or substance abuse services in the past six months.

Conclusion/Implications: These findings suggest that Hispanic women veterans may be less likely to utilize VA health services relative to other female veterans.  Although previous studies have identified affordability as the main reason for using VA services, lack of information about benefits has been suggested as a primary reason for non-utilization.  Being unaware of VA benefits may explain the decreased odds of help-seeking among Hispanic women veterans.  Community-based organizations that provide services to low-income Hispanic populations should screen clientele for prior military service and educate veteran clients on VA benefits.  Future policy efforts should advocate for expanded transitional VA benefits workshops prior to military discharge.