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Facing challenges: health care for rural veterans.


With more than three million veterans who use VA medical services living in rural areas, the delivery of health care is more difficult and more costly. A survey of 767,000 veterans by the VA Health Services Research and Development Office found that rural veterans are in poorer physical and mental health compared to those who live in urban areas.

The study found that access to care may be one reason rural veterans appear to be in poorer health, and officials suggested that VA consider coordinating services with Medicare or other health care systems based in rural areas. VA officials said community-based outpatient clinics, just getting established when the study was conducted, may not fully address the needs of rural veterans for specialty or hospital care.

"Congress last year appropriated $250 million to implement a new rural health outreach and delivery program," said National Legislative Director Joseph A. Violante. "This program is obviously needed by the nearly one-half of veterans who fought in Iraq and Afghanistan and now live in rural settings."

"But this is just a beginning of a pilot program that could cost billions of dollars, and without proper attention could threaten the high quality health care all veterans receive," Violante said. "There is a need to be filled, but it must be done judiciously with attention to the overall standards of high-quality health care."

During a March hearing of the House Veterans' Affairs Health Subcommittee, lawmakers addressed the funding and coordination of the new Office of Rural Health (ORH) as it narrows the health disparities of rural veterans.

During the hearing Deputy National Legislative Director Joy J. Ilem cautioned about the trend to contract for health care providers which could reduce the quality of care. "VA clearly faces major challenges and hurdles." Among them, she said, are "the trend toward privatization, vouchering and contracting of VA health care for rural veterans on a broad scale."

"VA's health care costs for veterans in rural areas will be more than for veterans who use VA medical centers," said Violante. "The funding for rural health care needs close attention, and any programs authorized by Congress should be fully funded to ensure the same high quality of care in rural areas as offered in the VA medical center environment."

A rural health care program operated by contractors could result in health care being provided by medical professionals less familiar with injuries and post-deployment mental health issues associated with combat and military service.

A Veterans Rural Health Advisory Committee, which advises the VA on health care issues affecting rural veterans, was appointed last year. National Judge Advocate Michael Dobmeier of South Grand Forks, N.D., was selected to serve on it.

"The ORH needs to be adequately funded, appropriately staffed and totally supported to improve the lives of disabled veterans and their families living in rural areas," said Violante. "It cannot remain a one-person office to provide the range of services needed. We urged in The Independent Budget to properly staff the office and elevate its importance in the VA hierarchy."

"DAV cannot stress enough the importance of communication and collaboration between this office [ORH], other VA program offices and field facilities, and other federal, state or local organizations, to reach out and provide VA benefits and services to veterans residing in rural and highly rural areas," Ilem testified. "We are concerned that the current staffing level assigned to the ORH will be insufficient to effectively carry out its mission."

Another concern is that the VA's excellent mental health programs may not always be available in rural areas. Private medical providers giving care under a VA contract would have little experience with combat veterans, posttraumatic stress disorder and traumatic brain injuries.

While Congress has approved a pilot program to provide peer outreach and support services through community mental health centers, the program is not yet operational.

And there is concern that the increased cost in caring for veterans in rural areas would siphon off funds needed at VA medical centers to provide a high standard of health care.

"Congress should monitor VA's funding allocation to ensure rural health needs are met and given equal attention," said Ilem. "In the long term, VA's methods and plans may offer rural and highly rural veterans better opportunities to obtain quality care to meet their specialized health care needs."

"We're pleased the VA is making progress on its rural health care initiatives," Violante said. "ORH has an ambitious agenda and is still a relatively new organization. Although it is on the threshold of tangible effectiveness, it faces many challenges ahead. And the DAV will closely monitor the program to help ensure it achieves its goal of improving care to rural veterans while not diminishing care for veterans elsewhere."

VA Funds Improved Care for Rural Veterans

The Department of Veterans Affairs has provided $215 million in competitive funding to improve services specifically designed for veterans in rural and highly rural areas.

Veterans Integrated Service Networks, VA's regional health care networks, and Veterans Health Administration program offices were allowed to submit up to eight proposed projects each. These proposals were prioritized and then sent to the Office of Rural Health (ORH), where they were evaluated based on, methodology, feasibility and intended impact on rural veterans.

After careful review, ORH selected 74 programs, many of which were either national in scope or affected multiple states.

The new funding is part of an ambitious program to improve access and quality of health care--both physical and mental--for veterans in geographically rural areas, with an emphasis on the use of the latest technologies, recruitment and retention of a well-educated and trained health care workforce, and collaborations with non-VA rural health community partners.

The VA created an Office of Rural Health in February 2007. In the past two years, VA formed a 16-member national committee to advise on issues affecting rural veterans, opened three Veterans Rural Health Resource Centers to study rural veterans issues, rolled out four new mobile health clinics to serve 24 predominately rural counties, announced 10 new rural outreach clinics to be opened in 2009.
Where Are
the Veterans? There are almost 8 million
veterans enrolled in the VA Health Care System.
About 3 million of them live in rural areas.

Rural,           36.3%  (2, 850,173)

Urban,           62.2%  (4,879,424)

Highly Rural,     1.5%  (118, 685)

Note: Table made from pie chart.
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Publication:DAV Magazine
Geographic Code:1USA
Date:Nov 1, 2009
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