“It’s Like Finding Your Way Through the Labyrinth”: a Qualitative Study of Veterans’ Experiences Accessing Healthcare

Background: The 2014 Veterans Choice Act and subsequent 2018 Veteran’s Affairs (VA) Maintaining Systems and Strengthening Integrated Outside Networks Act (MISSION Act) are legislation which clarified Veteran access to healthcare provided by non-VA clinicians (community care). These policies are of particular importance to Veterans living in rural areas, who tend to live farther from VA medical facilities than urban Veterans. Objective: To understand Veterans’ experiences of the MISSION Act and how it impacted their access to primary care to inform future interventions with a focus on reaching rural Veterans. Design: Qualitative descriptive design. Participants: United States (US) Veterans in Northwestern states engaged in VA and/or community care. Approach: Semi-structured interviews were conducted with a purposive sample of Veterans between August 2020 and September 2021. Interview domains focused on barriers and facilitators of healthcare access. Transcripts were analyzed using thematic analysis. Key Results: We interviewed 28 Veterans; 52% utilized community care as their primary source of care and 36% were from rural or frontier areas. Three main themes emerged: (1) Veterans described their healthcare experiences as positive but also frustrating (billing and prior authorization were noted as top frustrations); (2) Veterans with medical complexities, living far from healthcare services, and/or seeking women’s healthcare services experienced additional frustration due to increased touch points with VA systems and processes; and (3) financial resources and/or knowledge of the VA system insulated Veterans from frustration with healthcare navigation. Conclusions: Despite provisions in the MISSION Act, Veteran participants described persistent barriers to healthcare access. Patient characteristics that required increased interaction with VA processes exacerbated these barriers, while financial resources and VA system knowledge mitigated them. Interventions to improve care coordination or address access barriers across VA and community care settings could improve access and reduce health inequities for Veterans—especially those with medical complexities, those living far from healthcare services, or those seeking women’s healthcare.