The effect of distance to VA facilities on the choice and level of utilization of VA outpatient services.

The 1987 survey of Veterans is used to explain the effects of distance to VA facilities on the choice and level of utilization of VA outpatient services by U.S. veterans. A two part discrete/continuous model is used to separate two elements of the decision to seek outpatient services from federally operated VA facilities. First, a discrete choice is made to seek care from the VA. Second, a continuous choice is made to seek a particular level of utilization. Distance is found to affect the initial discrete choice significantly for measured distances up to 60 miles at a decreasing rate. Once some VA outpatient contact is made, distance is a major factor only for the elderly in determining the amount of utilization. Disturbingly, elderly veteran users living more than 30-40 miles from the nearest VA are expected to make fewer visits in a year than younger veterans.