Racial Variations in Department of Veterans Affairs Ambulatory Care Use and Unmet Health Care Needs

Abstract

Our objective was to describe racial/ethnic variations in Department of Veterans Affairs (VA) ambulatory care use and its association with the presence of unmet health care needs. Using the 1992 National Survey of Veterans, we examined race/ethnicity and unmet health care need for ambulatory care users of VA and non-VA facilities. Black and Hispanic veterans were more likely to report any VA use. In unadjusted analyses, American Indian/Eskimo, Hispanic, and black veterans were 4.4, 2.5, and 1.9 times more likely, respectively, than white veterans to report an inability to get needed care. Adjusting for VA ambulatory care use diminished the disparity in inability to get needed care between American Indian/Eskimo or Hispanic veterans and white veterans and eliminated the disparity between black and white veterans. Our findings support the VA's role as a medical safety net provider and suggest that VA ambulatory care use is effective in mitigating health-related racial disparities for some veterans. Additional facilitators for reducing unmet need should be explored.

Racial and Ethnic Disparities in the VA Health Care System: A Systematic Review

“…One study identified a cycle of passivity in which African American patients, and patients interacting with race discordant physicians, received less information overall because they engaged less often in communication behaviors (e.g., questions, assertions) that typically elicit more information from doctors. 48 In focus groups, African-American patients placed greater emphasis on the need for trust in their physicians in deciding about invasive procedures, whereas white patients placed greater emphasis on clinical indications. 49 Whereas racial differences were apparent in factors that might influence the use of cardiac care-e.g., aversion to surgery, trust, communication-studies that were able to examine the influence of these factors on the actual use of invasive procedures generally found that they did not explain observed disparities.…”

Transforming Clinical Practice to Eliminate Racial–Ethnic Disparities in Healthcare

“…4,5 Indeed, the IOM asserts that access-related factors may be the most significant barriers to equitable care, and they must be addressed as an important first step toward eliminating health care disparities. 10 …”

“…[1][2][3][4][5] Examples include disparities in receipt of surgical procedures, cancer care, intensity of hospital services, and treatment of pain. 2,3,[6][7][8][9] The Institute of Medicine (IOM) defines disparities in health care as racial or ethnic differences in the quality of health care that are not caused by differences in clinical need, patient preferences, or appropriateness of intervention.…”

“…10 Although many of the differences in health and health care use are related to differences in socioeconomic factors and access to care, most research has found that racial-ethnic disparities persist even after adjustment for these factors. [1][2][3][4][5]8,11,12 Elimination of racial-ethnic health care disparities requires action on multiple levels of health care organization and delivery. The IOM's report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," makes recommendations aimed at the health care system or institutional level.…”

Classification of Race and Ethnicity: Implications for Public Health

“…Variations associated with race or ethnicity may stem from differences in biology (132), behavior (94), and/or exposure to environmental factors (117). Similarly, variations in health outcomes have been linked to biologic determinants, social determinants, (5,121) and their interaction (53). Although race or ethnicity, per se, is not causal, it may still function as a risk indicator providing some reduction in uncertainty about the likelihood of morbidity or mortality (105).…”