Resistance to Switching Health Care Institution Among Veterans Referred for VA-Purchased Care

Background: Little is known about how Veterans choose between receiving Veterans Affairs (VA)–paid health care from VA-direct care (care provided in VA facilities) vs. non-VA facilities (VA-purchased care). Objective: To evaluate Veterans’ resistance to switch their hypothetical choice of health care institution with reasonable alterations in quality and access using Discrete Choice Experiments (DCE). Design: We conducted a nationwide survey among Veterans who had been offered a referral for VA-purchased care. Participants: Of the 12,547 Veterans we approached, 1253 (10.0%) respondents had evaluable data. Main Measures: We summarized DCE results. We evaluated the multi-variable adjusted association of travel time to the nearest VA facility (≤ 1 h vs. > 1 h) with resistance to switch health care institutions. We calculated predicted probabilities (PP) for resistance to switching and separately based on distrust in VA health care. Key Results: When respondents imagined their local VA facility was 1 h farther away than their local VA-purchased care facility, more than 60% chose VA-direct care for every quality and access improvement scenario (e.g., VA had higher quality of care). However, when all factors of care in both institutions were equal, up to 60% of respondents who initially chose VA-purchased care would not switch to VA-direct care for any incremental improvement in access and quality of VA-direct care. Travel time was not associated with high resistance to switching health care location (adjusted OR 1.1, 95% CI 0.8–1.4; p =.70). Respondents who originally chose VA-purchased care and had high distrust in VA had the highest predicted probabilities of resistance to switch (≤ 1 h travel time: PP 36%, CI 28–43%; > 1 h travel time: PP 42%, CI 34–49%). Conclusions: Interventions to increase Veterans choosing VA-direct care should improve Veterans’ understanding of VA and non-VA quality and access and also improve trust in VA.