Presentation (CTI)

OBJECTIVES: To examine racial and ethnic disparities in Veterans' healthcare experiences across VA and non-VA settings, focusing on: (1) provider knowledge of past health problems, (2) maintenance of complete health information, and (3) awareness of care received in other systems. Additionally, this study aimed to determine whether disparities were more pronounced in VA versus non-VA settings and identify potential socioeconomic mechanisms underlying these disparities.
METHODS: Using data from the 2018-2019 Medical Expenditure Panel Survey's Veteran Self-Administered Questionnaire (n=2,568 respondent years), we employed generalized estimating equations to estimate predicted probabilities of positive healthcare experiences among non-Hispanic White, non-Hispanic Black, and Hispanic Veterans. Models adjusted for demographic and health-related factors. Additional mediation analyses examined socioeconomic mechanisms, including education level, poverty level, and insurance coverage. All analyses incorporated complex survey design elements and pooled sampling weights.
RESULTS: Overall, non-Hispanic White Veterans reported higher probabilities of providers being knowledgeable about past health problems (77.7%) compared to non-Hispanic Black (65.4%) and Hispanic Veterans (63.9%). For maintenance of complete health information, disparities were larger in non-VA settings, with the gap between non-Hispanic Black and White Veterans 14.6 percentage points greater than for VA settings (95% confidence limits: 5.6, 23.5). Awareness of care received in other systems was consistently low (10-15%) across all groups and systems. Mediation analysis revealed insurance coverage explained 15.8% of the Black-White disparity in provider knowledge and fully explained differences in cross-system awareness, while education and poverty status showed no significant mediation effects.
CONCLUSIONS: While the VA healthcare system showed smaller racial/ethnic disparities than non-VA settings, gaps persist in Veterans' care experiences. These findings have important implications as the VA expands community care options. Results suggest the need for targeted interventions to improve information sharing and cultural competency, particularly in non-VA settings, to ensure equitable care experiences for all Veterans.