Resistance to Switching Health Care Institution Among Veterans Referred for VA-Purchased Care

Little is known about how Veterans choose between receiving Veterans Affairs (VA)-paid health care from VA-direct care (care provided in VA facilities) vs. non-VA facilities (VA-purchased care).

To evaluate Veterans' resistance to switch their hypothetical choice of health care institution with reasonable alterations in quality and access using Discrete Choice Experiments (DCE).

We conducted a nationwide survey among Veterans who had been offered a referral for VA-purchased care.

Of the 12,547 Veterans we approached, 1253 (10.0%) respondents had evaluable data.

We summarized DCE results. We evaluated the multi-variable adjusted association of travel time to the nearest VA facility (≤ 1 h vs. > 1 h) with resistance to switch health care institutions. We calculated predicted probabilities (PP) for resistance to switching and separately based on distrust in VA health care.

When respondents imagined their local VA facility was 1 h farther away than their local VA-purchased care facility, more than 60% chose VA-direct care for every quality and access improvement scenario (e.g., VA had higher quality of care). However, when all factors of care in both institutions were equal, up to 60% of respondents who initially chose VA-purchased care would not switch to VA-direct care for any incremental improvement in access and quality of VA-direct care. Travel time was not associated with high resistance to switching health care location (adjusted OR 1.1, 95% CI 0.8-1.4; p = .70). Respondents who originally chose VA-purchased care and had high distrust in VA had the highest predicted probabilities of resistance to switch (≤ 1 h travel time: PP 36%, CI 28-43%; > 1 h travel time: PP 42%, CI 34-49%).

Interventions to increase Veterans choosing VA-direct care should improve Veterans' understanding of VA and non-VA quality and access and also improve trust in VA.