Estimating National and Regional Primary Care Spending in the Veterans Health Administration in 2022

The Veterans Health Administration (VHA) historically has spent a larger percentage of total medical expenditures on primary care than other US payers, but more recent estimates are unknown. Further, no studies have identified whether geographic differences in primary care spending exist within the VHA's 18 regional Veteran Integrated Service Networks (VISNs). Our objective was to characterize the percent and per-Veteran absolute spending on primary care nationally and by VISN in the VHA in 2022.

We calculated primary care and total VHA spending in fiscal year 2022 nationally and by VISN. We then calculated the per-Veteran absolute spending and percent of total national expenditures attributed to primary care.

In 2022, VHA spent $848 per-Veteran on primary care (9.2% of total medical expenditures). Across the 18 VISNs, per-Veteran spending ranged from $641 to $1079, with the 25^th and 75^th percentiles ranging from $802 to $881. Primary care percent spending ranged from 7.1% to 11.2%, with the 25^th and 75^th percentile ranging from 8.5% to 9.7%. Only 6 of 18 VISNs were in the same quartile for primary care spending in each metric.

Primary care spending in the VHA in 2022 as a percentage of total medical expenditures was stable compared with prior estimates. In addition, our results show discordance in each VISN's spending quartile based on the metric utilized. This finding suggests that each metric may capture a different element of primary care spending.