Work

Increasing Veterans’ Access to Health Care After Legislated Expansion of VA Community CarePrograms: A Scoping Review

Year: 2026

Type: preprint

Abstract: Background In 2014, Congress passed the Veterans Access, Choice, and Accountability Act (Choice Act) to improve access to care, temporarily expanding VA-purchased Community Care (VA-CC) through a network of contracted community providers, with eligibility criteria based on appointment wait times and distance to care. In 2018, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act established a permanent, consolidated VA-CC program, providing new eligibility criteria, and expanding services. This scoping review summarizes the VA-CC literature since passage of the Choice Act across five domains: Access, Program Implementation, Quality, Coordination of Care, and Costs. Methods Four bibliographic databases were searched from 2014 to April 2023: Ovid MEDLINE, Embase, Cochrane CENTRAL, and CINAHL. A separate search identified RAND Corporation publications and U.S. Government Accountability Office’s (GAO) reports from 2014 to 2023. Fifteen publication characteristics were extracted including standard scoping review elements (e.g., publication year, key findings) and VA-CC specific variables such as legislation, domain, health care specialty area, and study participant type (e.g., Veterans, providers, staff). Results Of 2,284 unique records, 89 publications and 11 GAO reports were retained. Most assessed Access (n=60) or Coordination of Care (n=32), while 11 examined Costs. Nearly half (n=46) focused on specialty care, and approximately 80% (n=78) examined VA-CC in relation to Veterans (versus providers or staff). Few publications examined multiple domains or considered domains jointly (e.g., Access and Quality). Overall, VA-CC reduced drive times; however, wait times were largely unchanged, and some Veterans continued to travel farther than their nearest VA facility for care. Findings related to Quality and Costs were mixed, varying by population and outcomes examined. Publications addressing Coordination of Care and Program Implementation described both persistent challenges and potential solutions. Conclusions The Choice and MISSION Acts were designed to improve Veterans’ access to care, but they have also affected coordination, quality, and costs. Together, these findings underscore the need to evaluate multiple domains concurrently to understand the trade-offs and inform improvements across the health care delivery system.

Source: Research Square

DOI: 10.21203/rs.3.rs-9657762/v1