Funding: The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, and Veterans Rural Health Resource Center-Central Region (VRHRC-CR) and the Health Services Research and Development (HSR&D) Service through the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center (REA 09–220). The views expressed in this article are those of the authors and do not necessarily represent the views or policy of the Department of Veterans Affairs or the United States Government.
Unclaimed Health Care Benefits: A Mixed-Method Analysis of Rural Veterans
Article first published online: 22 JUL 2014
© 2014 National Rural Health Association
The Journal of Rural Health
Volume 31, Issue 1, pages 35–46, Winter 2015
How to Cite
Wittrock, S., Ono, S., Stewart, K., Reisinger, H. S. and Charlton, M. (2015), Unclaimed Health Care Benefits: A Mixed-Method Analysis of Rural Veterans. The Journal of Rural Health, 31: 35–46. doi: 10.1111/jrh.12082
Acknowledgments: The authors would like to thank Kyle Olin for his participation in the qualitative team, including assistance with recruitment, screening, and interviewing. We would also like to thank Thomas F. Klobucar for his assistance with the survey development and recruitment.
- Issue published online: 26 DEC 2014
- Article first published online: 22 JUL 2014
- Department of Veterans Affairs
- Veterans Health Administration
- Office of Rural Health
- Veterans Rural Health Resource Center-Central Region (VRHRC-CR)
- Health Services Research and Development (HSR&D) Service through the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center. Grant Number: REA 09–220
- health care;
- health services research;
Rural areas contribute a disproportionate number of US military recruits compared to urban areas. However, few studies have examined why many rural veterans do not enroll in the Veterans Health Administration (VHA) for health care. Our objective was to elicit reasons rural veterans chose not to use VHA.
This mixed-methods study included quantitative survey and qualitative interview data. Surveys were mailed to 4,176 households with a registered voter in a rural Midwestern county to reach the estimated 1,100 veterans, of whom 600 were not enrolled in VHA. Surveys were designed to assess demographics and basic eligibility requirements for VHA. Themes were derived deductively from survey responses and inductively as they emerged through analysis of interview transcripts.
A total of 180 veterans completed the survey and 165 were eligible based on an approximation of enrollment criteria. Of those, 74 (45%) were current VHA users, and 91 (55%) were nonusers of VHA but appeared to be eligible. The most common reason selected by these potentially eligible veterans for not using VHA was they did not think they were eligible (41%). Interviews revealed the issue of distance was superseded by the perception that enrollees must be poor and have experienced combat, injury, or disability during service. Most reported they had never been told about VHA health care benefits.
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.