Racial and Ethnic Differences in Healthcare Experiences for Veterans Receiving Care from VA and Non-VA Providers.

Abstract

Veterans increasingly receive care from both Veterans Affairs (VA) and non-VA providers, creating challenges for care coordination. Limited research has examined racial/ethnic disparities in Veterans' healthcare experiences across these dual systems. To examine racial/ethnic differences in the healthcare experiences of Veterans regarding provider knowledge of past health problems, maintenance of complete health records, and cross-system awareness, and determine whether disparities differ between VA and non-VA settings. Cross-sectional analysis using generalized estimating equations to estimate the differences in positive experiences and decomposition analysis to identify factors explaining disparities. In total, 1885 unique Veterans contributing 2568 respondent-years from the 2018-2019 Medical Expenditure Panel Survey Veteran Self-Administered Questionnaire, representing approximately 15.5 million Veteran-years nationally. Three self-reported patient experience outcomes: provider knowledge of past health problems, maintenance of complete health records, and provider awareness of care received in other systems. Non-Hispanic White Veterans reported more positive experiences than Black and Hispanic Veterans for provider knowledge (77.9% vs 62.0% and 61.1%) and record completeness (86.6% vs 72.9% and 67.2%). Disparities were larger in non-VA settings, particularly for record completeness, where the Black-White disparity was 15.5 percentage points larger in non-VA versus VA settings (95% CLs 4.4, 26.6). Cross-system awareness was uniformly low (10-15%) across all groups. Decomposition analysis revealed demographics explained 7.7 percentage points of Hispanic-White disparities in record completeness. Although disparities were smaller within VA than non-VA settings, meaningful gaps persist. Targeted interventions to improve care coordination and information sharing, especially in non-VA settings, are needed as community care expands. Not applicable.