Distance as a barrier to healthcare was not uniformly defined. Rather, its importance was relative to the health status and resources of patients, complexity of service provided, and urgency of service needed. Improved transportation, flexible fee-based services, more structured communication mechanisms, and integration with community resources will improve access to care and overall health status for rural veterans.

VA system barriers hinder communication between providers, possibly resulting in fragmented care. Addressing these barriers will potentially improve patient safety and satisfaction.

Results suggest that lack of awareness of VHA health care benefits may be the biggest barrier identified by rural veterans. Targeted outreach and education efforts related to eligibility for rural veterans are warranted.