United States General Accounting Office

GAO Report to the Ranking Minority Member,

Subcommittee on Compensation,

Pension, Insurance, and Memorial

Affairs, Committee on Veterans’ Affairs,

House of Representatives

December 1995 VA HEALTH CARE

How Distance From 

VA Facilities Affects

Veterans’ Use of VA

Services

GAO/HEHS-96-31

GAO United States

General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-259617 

December 20, 1995

The Honorable Lane Evans

Ranking Minority Member

Subcommittee on Compensation, Pension,

 Insurance, and Memorial Affairs

Committee on Veterans’ Affairs

House of Representatives

Dear Mr. Evans:

In fiscal year 1994, the Department of Veterans Affairs (VA) provided

medical care to about 2.5 million (9.4 percent) of the nation’s 26.5 million

veterans. Although VA operates one of the largest health care delivery

systems in the United States, veterans frequently indicate that they do not

use VA health services because they live too far from the nearest VA

hospital or outpatient clinic.

This report responds to your request for information relating to the role of

distance in predicting veterans’ use of VA health care. Specifically, it

answers the following questions:

• What percentage of the veteran population lives within selected distances

of a VA hospital and outpatient clinic offering basic acute medical and

surgical care?

• How does the distance a veteran lives from a VA hospital or outpatient

clinic affect the likelihood that he or she will use VA for acute medical and

surgical care?

• Is the number of services per veteran user higher for veterans living close

to a VA hospital or clinic?

• Is use of VA health care facilities by veterans receiving VA compensation for

service-connected disabilities or VA low-income pensions more or less

sensitive to how far they live from a VA facility than use by other veterans?

Scope and

Methodology

To develop this information, we used data from the 1990 Census and VA’s

patient treatment file, compensation and pension file,1

 and outpatient file.

We measured distances between veterans’ homes and the nearest VA

hospital and outpatient clinic based on the zip codes of VA facilities and

veterans’ residences. We focused our work on acute medical and surgical

1

Information in VA’s compensation and pension file was as of March 1993. Information in the patient

treatment file and outpatient file was for fiscal year 1993.

Page 1 GAO/HEHS-96-31 Distance From VA Facilities
B-259617 

care.2 Accordingly, we excluded from our universe of hospitals 40 VA

hospitals that (1) primarily provide long-term psychiatric care and (2) do

not provide surgical care. A total of 131 of VA’s 171 hospitals were included

in our universe. However, the patients discharged from all 171 hospitals

were included in our analyses except as noted below.

We then made several adjustments to data in the patient treatment file.

Because of our focus on acute medical and surgical care, we excluded

patients discharged from (1) psychiatric bed sections and (2) nonacute

bed sections, including patients discharged from nursing home and

intermediate care units; inpatient substance abuse treatment,

post-traumatic stress disorder, and respite care programs; and halfway

houses and hospices.

Similarly, we excluded from our analyses those VA outpatient clinics (and

the associated outpatient visits) that (1) primarily provide psychiatric

counseling or (2) do not provide a broad range of acute medical and

surgical care. We also excluded visits to community providers reimbursed

by VA on a fee basis. Veterans who used acute medical, surgical, or

psychiatric services as well as nonacute VA programs were included in our

analyses as users, but their nonacute services were excluded from the

analyses of the number of outpatient visits. Our universe included 269 VA

outpatient clinics that provide a wide range of acute medical and surgical

care.3

 (See app. I for a detailed description of our methodology.)

We conducted our work between May 1994 and August 1995 in accordance

with generally accepted government auditing standards.

Results in Brief Living within 5 miles of a VA hospital or outpatient clinic significantly

increases the likelihood that a veteran will use VA health care services.

Although most veterans live within 25 miles of a VA hospital and outpatient

clinic, use of VA facilities, in terms of both likelihood of VA use and the

frequency of use, declines significantly among veterans living more than 5

miles from a VA facility. Only about 11 percent of veterans live within 5

miles of a VA hospital providing acute medical and surgical care and

17 percent within 5 miles of a VA outpatient clinic.

2

Distance may also be an important factor in veterans’ decisions regarding use of VA psychiatric care.

We excluded psychiatric care from this analysis, however, because many psychiatric hospitals offer a

limited range of acute medical and surgical care. Their inclusion in the universe of facilities would,

therefore, give a misleading picture of the availability of acute medical and surgical hospital care.

3

A total of 256 zip codes were involved; 13 pairs of outpatient clinics had the same zip code.

Page 2 GAO/HEHS-96-31 Distance From VA Facilities
B-259617 

Use of VA health care services does not decline with distance as rapidly

among veterans receiving VA compensation or pension payments. Even

those veterans with service-connected disabilities who live more than 100

miles from a VA outpatient clinic are more likely to use VA outpatient

services than are higher income veterans with nonservice-connected

disabilities who live within 5 miles of a VA outpatient clinic.4

 A number of

factors, including broader eligibility and entitlement to outpatient care for

service-connected and low-income veterans, veterans’ ages, and

differences in available resources, could also contribute to the differences

in use of VA services.

Background In fiscal year 1993, VA operated 171 hospitals, 128 nursing homes, 38

domiciliaries, and 353 outpatient clinics. VA facilities vary widely in the

types and complexities of the services provided. For example, some of the

hospitals are large facilities providing a wide range of acute medical,

surgical, and psychiatric care. VA also operates smaller rural hospitals

providing more limited acute medical and surgical care. Still others

provide primarily long-term psychiatric care and do not perform surgery.

Similarly, there is considerable variability in the services available from VA

outpatient clinics. In addition to the outpatient clinics located within

medical centers, some VA medical centers operate satellite clinics in other

locations. VA also operates several large, independent outpatient clinics

and numerous smaller, community-based, rural outreach, and mobile

clinics providing a narrower range of services.

Most Veterans Live

Within 25 Miles of a

VA Acute Care Facility

About 89 percent of veterans live more than 5 miles from a VA hospital

providing acute medical and surgical care, but about 50 percent live within

25 miles. Similarly, approximately 83 percent of veterans live more than 5

miles from a VA outpatient clinic, but about two-thirds live within 25 miles.

(See fig. 1 and tables II.1 and II.2.)

4

This report uses the shorthand terms “service-connected veterans” and “nonservice-connected

veterans” to refer to these two groups. As used in this report, “higher income” refers to

nonservice-connected veterans not receiving a VA pension. This group includes an unknown number

of veterans with incomes below the level that would qualify them for a pension but who are not

receiving a VA pension. Data were not readily available to permit a more precise breakout of veterans’

incomes.

Page 3 GAO/HEHS-96-31 Distance From VA Facilities
B-259617 

Figure 1: Percentage of the Veteran

Population Living Within Selected

Distances of VA Acute Care Facilities

Percent

0

5

10

15

20

25

30

35

40

45

50

0-5 6-25 26-100 Over 100

Distance (Miles)

11

17

39

49

44

33

6

1

Hospital

Outpatient Clinic

Source: Based on 1990 Census data.

Veterans Living Within

5 Miles of a VA

Facility Most Likely to

Use VA

Veterans who live close to a VA facility are more likely to use VA hospital

and outpatient services, but users of outpatient services appear to be more

sensitive to distance. Although only 11 percent of veterans live within 5

miles of a VA hospital, such veterans account for 22 percent of VA acute

medical and surgical patients. Similarly, the 17 percent of veterans living

within 5 miles of a VA outpatient clinic accounted for 26 percent of

outpatient clinic users. (See fig. 2 and tables II.1 and II.2.)

Page 4 GAO/HEHS-96-31 Distance From VA Facilities
B-259617 

Figure 2: Percentage of Veterans

Using VA Health Care Services, by

Distance From VA Acute Care

Facilities

Percent

0

5

10

15

20

25

30

35

40

45

50

0-5 6-25 26-100 Over 100

Distance (Miles)

22

26

34

42

39

31

5

1

Hospital

Outpatient Clinic

Source: Based on VA’s fiscal year 1993 patient treatment and outpatient files.

In other words, for every 1,000 veterans living within 5 miles of a VA

hospital, there were 34 who used a VA hospital for acute medical or

surgical care in fiscal year 1993; at greater distances from a VA hospital,

only about 15 used VA hospital care. Similarly, the number of outpatient

users per 1,000 veterans was significantly higher for veterans living within

5 miles of a VA outpatient clinic—131 per 1,000 veterans—than at greater

distances—fewer than 80 per 1,000 veterans. (See fig. 3 and tables II.1 

and II.2.)

Page 5 GAO/HEHS-96-31 Distance From VA Facilities
B-259617 

Figure 3: Users per 1,000 Veterans, by

Distance From VA Acute Care

Facilities

Users/1,000 Veterans

0

15

30

45

60

75

90

105

120

135

150

0-5 6-25 26-100 Over 100

Distance (Miles)

34

131

15

72

15

79

14

77

Hospital

Outpatient

Volume of Services

Used Is Also Sensitive

to Distance

Distance also appears to play a role in the volume of services used.

Generally, the number of outpatient visits per user decreased as veterans’

distances from VA clinics increased. For example, the 26 percent of VA

users living within 5 miles of a VA outpatient clinic accounted for

35 percent of outpatient visits. VA officials pointed out that visits may not

be the best measure of the volume of services veterans use; veterans

traveling longer distances to a VA clinic may make fewer visits but have

more clinic stops on those visits than veterans living closer to the VA

facility. Distance had little impact on the number of inpatient episodes of

care VA users obtained from VA hospitals. (See fig. 4 and tables II.3 

and II.4.)

Page 6 GAO/HEHS-96-31 Distance From VA Facilities
B-259617 

Figure 4: Services per Veteran User, by

Distance From VA Acute Care Facility Discharges/Visits per User

0

3.00

6.00

9.00

12.00

15.00

0-5 6-25 26-100 Over 100

Distance (Miles)

2

13

2

10

2

7

2

5

Inpatient

Outpatient

Service-Connected

and Low-Income

Veterans Less

Sensitive to Distance

Veterans receiving compensation for service-connected disabilities or VA

low-income pensions for nonservice-connected disabilities appear less

sensitive to distance than other veterans. Veterans receiving VA

compensation or pension payments are significantly more likely to use VA

health care services than other veterans with no service-connected

disabilities regardless of how far they live from a VA hospital or outpatient

clinic. And, their use of VA health care services does not decline as quickly

at increasing distances from VA facilities. For example, use of VA outpatient

clinics by veterans with service-connected disabilities rated at 50 percent

or higher declined by about 10 percent, from 704 users per 1,000 veterans

living within 5 miles of a VA outpatient clinic to 630 users per 1,000

veterans living between 6 and 25 miles from a clinic. By contrast, use by

nonservice-connected veterans not receiving VA pensions declined by over

50 percent, from 91 users per 1,000 veterans living within 5 miles of a VA

outpatient clinic to 45 users per 1,000 veterans living between 6 and 25

miles from a clinic. (See fig. 5 and tables II.13 through II.14.)

Page 7 GAO/HEHS-96-31 Distance From VA Facilities
B-259617 

Figure 5: VA Outpatient Clinic Users per 1,000 Veterans, by Distance and Service-Connected Status

1000

900

800

700

600

500

400

300

200

100

704

360

574

91

45

293

491

630

589

411

271

48 50

254

388

518

0-5 6-25 26-100 Over 100

Distance (Miles)

SC 50% or More

SC Less Than 50%

NSC Pension

Other NSC

Users per 1,000 Veterans

0

(Figure notes on next page)

Page 8 GAO/HEHS-96-31 Distance From VA Facilities
B-259617 

Notes: SC is service-connected veteran; NSC is nonservice-connected veteran.

Figure is based on fiscal year 1993 data.

In addition to being more likely to use VA hospitals and outpatient clinics,

veterans receiving (1) compensation for service-connected disabilities

rated at 50 percent or higher or (2) nonservice-connected pensions use a

higher volume of services than higher income nonservice-connected

veterans. Veterans receiving compensation for service-connected

disabilities rated at less than 50 percent are more likely to use VA services

than higher income nonservice-connected veterans, but both types of

users have roughly comparable numbers of discharges and outpatient

visits. (See fig. 6 and tables II.11 and II.12.)

Page 9 GAO/HEHS-96-31 Distance From VA Facilities
B-259617 

Figure 6: VA Outpatient Visits per Veteran User, by Distance and Service-Connected Status

20

18

16

14

12

10

8

6

4

2

20

11

17

11

8

9

13

16

10

8

6 6

4

5

6

7

0-5 6-25 26-100 Over 100

Distance (Miles)

SC 50% or More

SC Less Than 50%

NSC Pension

Other NSC

Visits per User

0

(Figure notes on next page)

Page 10 GAO/HEHS-96-31 Distance From VA Facilities
B-259617 

Notes: SC is service-connected veteran; NSC is nonservice-connected veteran.

Figure is based on fiscal year 1993 data.

Several factors other than distance could help explain the differences. For

example, service-connected veterans, particularly those with disabilities

rated at 50 percent or more, have broader eligibility for VA outpatient

services than do nonservice-connected veterans. Similarly, VA pension

recipients probably have fewer health care options than higher income

veterans. For example, they are unlikely to have employer-provided health

insurance and may be unable to afford the out-of-pocket costs they would

incur through use of their Medicare benefits.

Agency Comments

and Our Evaluation

We obtained comments on a draft of this report from the Deputy Under

Secretary for Health and other VA officials. The Deputy Under Secretary

said accessibility is an important aspect of quality health care and making

VA health care services more accessible has long been a goal of VA. He said,

however, that efforts to open additional outpatient “access point” clinics

have been delayed until VA can communicate the details of its plans to the

Congress. VA’s recent reorganization into 22 service networks will provide

veterans better access to care, the Deputy Under Secretary said.

VA officials expressed the following concerns about our methodology:

• Distance may not be as important as travel time in veterans’ decisions

about whether to use VA health care facilities. In their view, distance does

not account for and is not representative of geographic barriers, road

conditions, congestion, and other factors that might influence veterans’

use of VA medical centers. We agree and previously identified this

limitation in our scope and methodology (see p. 18). We are not aware of

any database that would have enabled us to measure veterans’ travel times

from VA medical centers.

Page 11 GAO/HEHS-96-31 Distance From VA Facilities
B-259617 

• Excluding psychiatric and long-term care facilities distorted our analyses.

About 50 percent of VA medical and surgical patients have some lifetime

psychiatric diagnoses or recurring symptoms. With limited availability and

funding for psychiatric care in the private sector, veterans may be more

willing to travel to VA facilities for these services. As a result, access to VA

psychiatric care affects veterans’ willingness to travel to VA. Also, VA

facilities that offer medical and surgical care as well as psychiatric

services are large and provide a significant portion of care rendered by VA.

We agree that veterans seeking VA psychiatric services may be less

sensitive to distance than those seeking medical or surgical care and that

the role of distance in predicting use of VA psychiatric care may warrant

further study. However, including facilities that do not provide a wide

range of medical and surgical services in an evaluation of the role of

distance in predicting the use of VA medical and surgical care would distort

the results of that analysis. Moreover, veterans who used both medical or

surgical services and psychiatric services in fiscal year 1993 were included

in our analyses regardless of whether they were treated in the excluded

facilities.

• Visits may not be an appropriate indicator of volume. Patients who travel

greater distances to VA combine many clinic stops into one visit, thereby

increasing the intensity of the care for each visit. We agree and recognized

this limitation in our report (see p. 6). Although VA’s point appears logical,

we are not aware of any studies that show the extent to which veterans

living greater distances from VA facilities obtain more services per visit

than veterans living closer to VA facilities.

• Our percentage distributions by distance compare the user population

with the entire veteran population, but the report does not contain the

same types of analyses for nonusers. Data on nonusers can easily be

derived from the tables in appendix II.

We are sending copies of this report to the Chairmen and Ranking

Minority Members of the Senate and House Committees on Veterans’

Affairs and the Secretary of Veterans Affairs. Copies will be made available

to others upon request.

This work was performed under the direction of James R. Linz, Assistant

Director, who may be reached at (202) 512-7110 if you or your staff have

Page 12 GAO/HEHS-96-31 Distance From VA Facilities
B-259617 

questions concerning this report. Other major contributors include Linda

Diggs, Sibyl Tilson, and Joan Vogel.

Sincerely yours,

David P. Baine

Director, Health Care Delivery

 and Quality Issues

Page 13 GAO/HEHS-96-31 Distance From VA Facilities
Contents

Letter 1

Appendix I 

Scope and

Methodology

16

Developing a Universe of VA Hospitals 16

Developing a Universe of Medical and Surgical Hospital Users 16

Developing Outpatient Universes 16

Determining How Many Veterans Live Within Selected Distances

of VA Facilities

17

Determining How Distance Affects Likelihood of VA Use 18

Determining the Effect of Distance on Volume of Services 18

Determining Whether Service-Connected Veterans and Pension

Recipients Are More Sensitive to Distance

18

Appendix II 

Veteran Population

and VA Users by

Distance From VA

Facilities

20

Tables Table I.1: Summary of Data Exclusions From VA’s Inpatient

Treatment File

16

 Table I.2: Summary of Data Exclusions From VA’s Outpatient

Clinic File

17

Table II.1: Distribution of Veterans and Users per 1,000 Veterans

by Distance to VA Acute Care Hospitals

20

Table II.2: Distribution of Veterans and Users per 1,000 Veterans

by Distance to VA Outpatient Clinics Providing Acute Care

20

Table II.3: Number of VA Hospital Discharges per Veteran User

by Distance From Nearest VA Hospital Providing Acute Care

20

Table II.4: Number of VA Outpatient Visits per Veteran User by

Distance From Nearest VA Outpatient Clinic Providing Acute

Care

21

Table II.5: Distribution of Veterans by Distance to Nearest VA

Acute Care Hospital by Service-Connected Status

21

Table II.6: Distribution of Veterans by Distance to Nearest VA

Outpatient Clinic Providing Acute Care by Service-Connected

Status

21

Page 14 GAO/HEHS-96-31 Distance From VA Facilities
Contents

Table II.7: Distribution of Veterans Using VA Acute Care

Hospitals by Distance and Service-Connected Status

22

 Table II.8: Distribution of Veterans Who Used VA Outpatient

Clinics Providing Acute Care by Distance and Service-Connected

Status

22

Table II.9: Acute Care Hospital Discharges by Distance and

Service-Connected Status

22

Table II.10: Visits to VA Outpatient Clinics Providing Acute Care

by Distance and Service-Connected Status

23

Table II.11: Acute Care Hospital Discharges per Veteran User by

Distance and Service-Connected Status

23

Table II.12: VA Outpatient Visits per Veteran User by Distance

and Service-Connected Status

23

Table II.13: Users of VA Acute Hospital Care per 1,000 Veterans

by Distance to VA Inpatient Facilities and Service-Connected

Status

24

Table II.14: Users of VA Outpatient Clinics per 1,000 Veterans by

Distance to VA Outpatient Clinics and Service-Connected Status 

24

Figures Figure 1: Percentage of the Veteran Population Living Within

Selected Distances of VA Acute Care Facilities

4

Figure 2: Percentage of Veterans Using VA Health Care Services,

by Distance From VA Acute Care Facilities

5

Figure 3: Users per 1,000 Veterans, by Distance From VA Acute

Care Facilities

6

Figure 4: Services per Veteran User, by Distance From VA Acute

Care Facility

7

Figure 5: VA Outpatient Clinic Users per 1,000 Veterans, by

Distance and Service-Connected Status

8

Figure 6: VA Outpatient Visits per Veteran User, by Distance and

Service-Connected Status

10

Abbreviations

CHAMPUS Civilian Health and Medical Program of the Uniformed

Services

NSC nonservice-connected

SC service-connected

VA Department of Veterans Affairs

Page 15 GAO/HEHS-96-31 Distance From VA Facilities
Appendix I 

Scope and Methodology

This appendix provides additional details on development of the universes

of VA hospitals, outpatient clinics, and users on which our analyses were

based and the methodologies used in our analyses.

Developing a Universe

of VA Hospitals

In fiscal year 1993, VA operated 171 hospitals, some of which provided only

limited acute medical and surgical care services. To develop a universe of

VA hospitals providing acute medical and surgical care for our analyses, we

excluded 40 hospitals that (1) primarily provide long-term psychiatric

care, (2) do not provide surgical care, or (3) are located outside the 48

contiguous states (that is, are located in Alaska and Puerto Rico). Hence,

131 hospitals were included in our universe of VA acute medical and

surgical hospitals. However, the patients discharged from all 171 hospitals

were included in our analyses except as noted below.

Developing a Universe

of Medical and

Surgical Hospital

Users

From VA’s fiscal year 1993 patient treatment file, we developed a universe

of veteran users of VA acute medical and surgical hospital care by

(1) excluding all discharges (6,219) of nonveterans (5,159) who used VA

inpatient services; (2) deleting discharges from state veterans’ homes and

other non-VA facilities; (3) deleting discharges from VA nursing homes and

domiciliaries; (4) deleting discharges from psychiatric bed sections; and

(5) deleting discharges from nonacute bed sections, including inpatient

substance abuse treatment programs, post-traumatic stress disorder

programs, respite care programs, halfway houses, and hospices. Veterans

who used both acute medical or surgical services and nonacute VA

programs were included in our analyses as users, but their nonacute

episodes of care were excluded from our analyses of the numbers of

veterans’ inpatient stays. The inpatient analyses included 462,809 veterans

and about 777,190 discharges (see table I.1).

Table I.1: Summary of Data Exclusions

From VA’s Inpatient Treatment File

Type of adjustment

Original

universe Exclusions

Adjusted

universe

Inpatient discharges 910,867 133,677 777,190

Hospitals 171 40 131

Veteran users 479,512 16,703 462,809

Developing Outpatient

Universes

In fiscal year 1993, VA operated 353 outpatient clinics, including many

providing primarily mental health services or only a narrow range of

medical services. To develop a universe of VA outpatient clinics offering a

Page 16 GAO/HEHS-96-31 Distance From VA Facilities
Appendix I 

Scope and Methodology

broad range of acute medical and surgical services, we excluded

(1) mobile clinics and other clinics offering primarily eligibility screening,

substance abuse outreach, mental health, or psychiatric services; and

(2) clinics located outside the 48 contiguous states (that is, clinics in

Alaska, Hawaii, and Puerto Rico). A total of 84 of VA’s 353 outpatient

clinics were excluded. From VA’s fiscal year 1993 outpatient file, we

developed a universe of veteran users by excluding (1) all visits to the 84

outpatient clinics removed from our universe; (2) all visits (995,323) to VA

clinics by nonveterans (328,418), such as beneficiaries in the Civilian

Health and Medical Program of the Uniformed Services (CHAMPUS) or VA

employees; and (3) outpatient visits to community providers who were

reimbursed by VA on a fee basis. After adjustments, our analyses included

269 outpatient clinics, approximately 2.3 million outpatient users, and

about 21.6 million visits.5

 (See table I.2.)

Table I.2: Summary of Data Exclusions

From VA’s Outpatient Clinic File

Type of adjustment

Original

universe Exclusions

Adjusted

universe

Outpatient visits 23,329,333 1,681,898 21,647,435

Clinics 353 84 269

Veteran users 2,626,228 352,221 2,274,007

Determining How

Many Veterans Live

Within Selected

Distances of VA

Facilities

To determine how many veterans live within selected distances of VA

hospitals and outpatient clinics offering a broad range of acute medical

and surgical care, we

• measured the straight-line distance between every residential zip code in

the 48 contiguous states and the nearest VA hospital and outpatient clinic

included in our universes;

• determined how many veterans lived within each zip code using 1990

Census data; and

• compiled the data on number of veterans living in each zip code in 5-mile

increments from the closest VA hospital and outpatient clinic.

5

A total of 256 zip codes were involved; 13 pairs of outpatient clinics had the same zip code.

Page 17 GAO/HEHS-96-31 Distance From VA Facilities
Appendix I 

Scope and Methodology

Determining How

Distance Affects

Likelihood of VA Use

To determine the effect of distance on the likelihood that veterans will use

VA hospital and outpatient services, we

• determined the number of VA users in each zip code in the 48 contiguous

states (using data from the fiscal year 1993 patient treatment file and

outpatient file) for both hospital and outpatient care;

• calculated the percentage of the user population living within 5-mile

increments of the closest VA inpatient hospital and outpatient clinic; and

• compared the proportion of users with the proportion of veterans living

within selected distances of VA facilities.

Determining the

Effect of Distance on

Volume of Services

To determine whether distance affected the volume of services VA users

obtain from VA, we

• calculated the number of hospital stays and outpatient visits for each VA

user in our universe;

• calculated the percentage of the visits or discharges attributed to users

living within 5-mile increments of the closest VA inpatient hospital or

outpatient clinic; and

• compared the proportion of visits or discharges with the proportion of

users living within selected distances of VA facilities.

Determining Whether

Service-Connected

Veterans and Pension

Recipients Are More

Sensitive to Distance

To determine whether veterans with service-connected disabilities or

receiving VA pensions are more or less sensitive to distance, we

• established a universe of service-connected veterans and veterans

receiving VA pensions using VA’s compensation and pension file;6

• conducted the analyses previously described for veterans receiving VA

compensation or pension payments; and

• compared the results with those of nonservice-connected veterans not

receiving pensions.

Our analyses have several limitations. First, the use of straight-line

distance between zip codes does not account for differences in travel time

due to road conditions, congestion, or structures such as bridges or

tunnels, or differences in travel distances caused by geographic barriers

such as rivers and mountains. Second, veterans do not always use the VA

facilities closest to their homes or may use multiple facilities or move

6

Information in VA’s compensation and pension file was as of March 1993.

Page 18 GAO/HEHS-96-31 Distance From VA Facilities
Appendix I 

Scope and Methodology

during the year. Third, the accuracy of the zip code data in VA’s patient

treatment file and outpatient file was not verified.

We conducted our work between May 1994 and August 1995 in accordance

with generally accepted government auditing standards.

Page 19 GAO/HEHS-96-31 Distance From VA Facilities
Appendix II 

Veteran Population and VA Users by

Distance From VA Facilities

This appendix contains tables showing the distribution of the veteran

population and VA users by distance from VA hospitals and outpatient

clinics providing acute medical and surgical care. The first 4 tables provide

information on the overall veteran population; the remaining 10 tables

provide a more detailed breakout of the veteran population by

service-connected status. The tables are based on our analyses of VA’s

fiscal year 1993 patient treatment file, outpatient file, and compensation

and pension file along with 1990 Census data.

Table II.1: Distribution of Veterans and

Users per 1,000 Veterans by Distance

to VA Acute Care Hospitals (Fiscal

Year 1993) 

Veterans Users

Distance (miles) Number Percentage Number Percentage

Users per

1,000

veterans

0-5 3,004,187 11 101,722 22 33.86

6-25 10,441,653 39 159,612 34 15.29

26-100 11,861,595 44 178,956 39 15.09

Over 100 1,641,587 6 22,519 5 13.72

Total 26,949,022 100 462,809 100 17.17

Table II.2: Distribution of Veterans and

Users per 1,000 Veterans by Distance

to VA Outpatient Clinics Providing

Acute Care (Fiscal Year 1993) 

Veterans Users

Distance (miles) Number Percentage Number Percentage

Users per

1,000

veterans

0-5 4,488,856 17 589,383 26 131.30

6-25 13,275,406 49 959,788 42 72.30

26-100 8,830,577 33 697,430 31 78.98

Over 100 354,183 1 27,406 1 77.38

Total 26,949,022 100 2,274,007 100 84.38

Table II.3: Number of VA Hospital

Discharges per Veteran User by

Distance From Nearest VA Hospital

Providing Acute Care (Fiscal Year

1993) 

Distance

(miles) Hospital users Hospital discharges

Discharges per veteran

user

0-5 101,722 176,058 1.73

6-25 159,612 270,814 1.70

26-100 178,956 294,666 1.65

Over 100 22,519 35,652 1.58

Total 462,809 777,190 1.68

Page 20 GAO/HEHS-96-31 Distance From VA Facilities
Appendix II 

Veteran Population and VA Users by

Distance From VA Facilities

Table II.4: Number of VA Outpatient

Visits per Veteran User by Distance

From Nearest VA Outpatient Clinic

Providing Acute Care (Fiscal Year

1993) 

Distance (miles)

Outpatient

users

Outpatient

visits

Visits per veteran

user

0-5 589,383 7,545,737 12.80

6-25 959,788 9,346,471 9.74

26-100 697,430 4,624,823 6.63

Over 100 27,406 130,404 4.76

Total 2,274,007 21,647,435 9.52

Table II.5: Distribution of Veterans by Distance to Nearest VA Acute Care Hospital by Service-Connected Status (1990) 

50-percent disabled or

greater

Less than 50-percent

disabled Receiving VA pension Other

Service-connected status

Nonservice-connected status

Distance (miles) Number Percentage Number Percentage Number Percentage Number Percentage

0-5 55,651 13 201,426 12 71,341 16 2,675,769 11

6-25 150,069 34 631,550 38 112,058 25 9,547,976 39

26-100 199,781 46 726,298 43 236,702 52 10,698,814 44

Over 100 32,231 7 113,331 7 33,506 7 1,462,519 6

Total 437,732 100 1,672,605 100 453,607 100 24,385,078 100

Table II.6: Distribution of Veterans by Distance to Nearest VA Outpatient Clinic Providing Acute Care by Service-Connected

Status (1990) 

50-percent disabled or

greater

Less than 50-percent

disabled Receiving VA pension Other

Service-connected status

Nonservice-connected status

Distance (miles) Number Percentage Number Percentage Number Percentage Number Percentage

0-5 83,981 19 304,439 18 100,673 22 3,999,763 16

6-25 194,860 45 811,855 49 142,685 31 12,126,006 50

26-100 152,958 35 535,991 32 202,057 45 7,939,571 33

Over 100 5,933 1 20,320 1 8,192 2 319,738 1

Total 437,732 100 1,672,605 100 453,607 100 24,385,078 100

Page 21 GAO/HEHS-96-31 Distance From VA Facilities
Appendix II 

Veteran Population and VA Users by

Distance From VA Facilities

Table II.7: Distribution of Veterans Using VA Acute Care Hospitals by Distance and Service-Connected Status (Fiscal Year

1993) 

50-percent disabled or

greater

Less than 50-percent

disabled Receiving VA pension Other

Service-connected status

Nonservice-connected status

Distance (miles) Number Percentage Number Percentage Number Percentage Number Percentage

0-5 11,596 18 14,026 20 16,435 23 59,665 24

6-25 23,340 35 25,446 36 20,927 29 89,899 35

26-100 27,270 41 27,547 39 31,672 43 92,467 36

Over 100 3,571 5 3,694 5 3,822 5 11,432 5

Total 65,777 100 70,713 100 72,856 100 253,463 100

Note: Percentages may not add to 100 because of rounding.

Table II.8: Distribution of Veterans Who Used VA Outpatient Clinics Providing Acute Care by Distance and

Service-Connected Status (Fiscal Year 1993)

50-percent disabled or

greater

Less than 50-percent

disabled Receiving VA pension Other

Service-connected status

Nonservice-connected status

Distance (miles) Number Percentage Number Percentage Number Percentage Number Percentage

0-5 59,082 21 109,706 23 57,779 27 362,816 28

6-25 122,713 45 221,233 46 70,102 33 545,740 42

26-100 90,110 33 145,363 30 83,075 39 378,882 29

Over 100 3,072 1 5,164 1 3,176 1 15,994 1

Total 274,977 100 481,466 100 214,132 100 1,303,432 100

Table II.9: Acute Care Hospital Discharges by Distance and Service-Connected Status (Fiscal Year 1993) 

50-percent disabled or

greater

Less than 50-percent

disabled Receiving VA pension Other

Service-connected status

Nonservice-connected status

Distance (miles) Number Percentage Number Percentage Number Percentage Number Percentage

0-5 22,272 19 23,748 21 31,431 24 98,607 24

6-25 42,847 36 41,504 36 39,601 30 146,862 36

26-100 47,262 40 43,249 38 55,086 42 149,069 36

Over 100 5,678 5 5,447 5 6,434 5 18,093 4

Total 118,059 100 113,948 100 132,552 100 412,631 100

Note: Percentages may add to more than 100 because of rounding.

Page 22 GAO/HEHS-96-31 Distance From VA Facilities
Appendix II 

Veteran Population and VA Users by

Distance From VA Facilities

Table II.10: Visits to VA Outpatient Clinics Providing Acute Care by Distance and Service-Connected Status (Fiscal Year

1993) 

50-percent disabled or

greater

Less than 50-percent

disabled Receiving VA pension Other

Service-connected status

Nonservice-connected status

Distance (miles) Number Percentage Number Percentage Number Percentage Number Percentage

0-5 1,199,642 29 1,248,138 30 959,431 39 4,138,526 38

6-25 1,966,771 48 1,927,195 47 878,931 35 4,573,574 42

26-100 897,253 22 920,704 22 633,551 25 2,173,315 20

Over 100 21,023 1 24,480 1 17,954 1 66,947 1

Total 4,084,689 100 4,120,517 100 2,489,867 100 10,952,362 100

Note: Percentages may add to more than 100 because of rounding.

Table II.11: Acute Care Hospital

Discharges per Veteran User by

Distance and Service-Connected

Status (Fiscal Year 1993) 

Service-connected status Nonservice-connected

status

Distance (miles)

50-percent

disabled or

greater

Less than

50-percent

disabled

Receiving

VA pension Other

0-5 1.92 1.69 1.91 1.65

6-25 1.84 1.63 1.89 1.63

26-100 1.73 1.57 1.74 1.61

Over 100 1.59 1.47 1.68 1.58

Total 1.79 1.61 1.82 1.63

Table II.12: VA Outpatient Visits per

Veteran User by Distance and

Service-Connected Status (Fiscal Year

1993) 

Service-connected status Nonservice-connected

status

Distance (miles)

50-percent

disabled or

greater

Less than

50-percent

disabled

Receiving

VA pension Other

0-5 20.30 11.38 16.61 11.41

6-25 16.03 8.71 12.54 8.38

26-100 9.96 6.33 7.63 5.74

Over 100 6.84 4.74 5.65 4.19

Total 14.85 8.56 11.63 8.40

Page 23 GAO/HEHS-96-31 Distance From VA Facilities
Appendix II 

Veteran Population and VA Users by

Distance From VA Facilities

Table II.13: Users of VA Acute Hospital

Care per 1,000 Veterans by Distance to

VA Inpatient Facilities and

Service-Connected Status (Fiscal Year

1993) 

Service-connected status Nonservice-connected

status

Distance (miles)

50-percent

disabled or

greater

Less than

50-percent

disabled

Receiving

VA pension Other

0-5 208.37 69.63 230.37 22.30

6-25 155.53 40.29 186.75 9.42

26-100 136.50 37.93 133.81 8.64

Over 100 110.79 32.59 114.07 7.82

Total 150.27 42.28 160.61 10.39

Table II.14: Users of VA Outpatient

Clinics per 1,000 Veterans by Distance

to VA Outpatient Clinics and

Service-Connected Status 

(Fiscal Year 1993) 

Service-connected status Nonservice-connected

status

Distance (miles)

50-percent

disabled or

greater

Less than

50-percent

disabled

Receiving

VA pension Other

0-5 703.52 360.35 573.93 90.71

6-25 629.75 272.50 491.31 45.01

26-100 589.12 271.20 411.15 47.72

Over 100 517.78 254.13 387.70 50.02

Total 628.19 287.85 472.07 53.45

(406088) Page 24 GAO/HEHS-96-31 Distance From VA Facilities
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