A Mixed Methods Study: Health Care Utilization Among Women Veterans

Background and Purpose: The demographics of the military population are changing, and there are more women veterans, active duty, and new recruits, than there have ever been in military history (Haskell et al., 2011). Moreover, research has suggested that women veterans have higher risk for mental and physical health issues, and trauma (Elbogen et al., 2013). With this increase of women in the armed services and their needs, it is imperative to understand health care utilization among women veterans and barriers to accessing care. Further, health care utilization among racial/ethnic minority women veterans and women veterans with low socioeconomic status (SES) is poorly understood. The present study aimed to examine the relations among gender, SES, minority status, health care utilization and barriers to health care. While most existing studies heavily focused on health care utilization at Veteran Affairs (VA), the current study examined health care utilization in broader health care settings.

Methods: This mixed-methods study included a quantitative analysis of the 2010 National Survey of Veterans data from a representative sample of 4,442 veterans (473 women, 10.6%) and a qualitative analysis of the semi-structured interviews with a convenient sample of six women veterans conducted in 2022. Gender was measured through a self-report question of male/female. SES was operationalized by income, education, supplemental security income, and service-connected disability. Health care utilization was measured through 7 yes/no questions asking use of dental care, emergency room, outpatient and inpatient care, prescription medication, mental health care, and VA health care. Minority status was operationalized through race/ethnicity other than white. A series of binary logistic regression and multiple linear regression analyses were performed. The participants of the qualitative study were recruited through the Veterans Resource Center at a public university in west coast region of the U.S. A 45-minute interview utilized a 15-item semi-structured interview guide. Thematic analysis was performed.

Results: Results of the quantitative analyses indicated that being a woman increased the odds of utilizing all health care services except inpatient care. Further, lower SES decreased the odds of utilizing dental care, emergency room use, outpatient care, and mental health care. Conversely, lower SES increased odds of being hospitalized and using VA health care. Identifying as a minority increased the odds of utilizing the emergency room and decreased the odds of utilizing dental care. Themes that emerged from the qualitative analysis included higher satisfaction with VA care compared to active duty care, lower satisfaction with specialty care at the VA, insensitivity to women’s health issues, and perceived stigma as a barrier to care.

Conclusions and Implications: These results are consistent with the findings that women veterans are higher users of health care services. Moreover, having a lower SES is a barrier to receiving health care services in other health care settings and many low-income women veterans turn to the VA for care. The implications of these findings are that health care providers must work to provide culturally tailored service to women veterans and increase engagement among those with low SES.