The arrangement makes it possible for the VA system to offer comprehensive women's health care, especially where the volume of women seeking care is not high enough to ensure quality in a particular service on-site, says Donna L. Washington, M.D., M.P.H., of the VA Greater Los Angeles Healthcare System.
"Despite widespread overall service availability, however, on-site 'one-stop shopping' is routinely available only for basic primary care services," Washington and her colleagues say.
The researchers surveyed 166 VA facilities nationwide, all of which served 400 or more women veterans in 2000, to determine how basic and specialized women's health services were offered. The 166 facilities serve more than 80 percent of the women who use the VA health care system.
Ninety-three percent of the facilities offered at least seven of nine basic health care services, like Pap smears and birth control prescriptions, within the facility. Sexual trauma counseling, a specialized service, was also offered on-site at 96 percent of the facilities.
Other specialized services, however, were often provided off-site through a contract with outside health care facilities. Such specialized services include breast cancer surgery, certain types of mammography and prenatal care.
Facilities with a greater number of specialist physicians and a separate women's health budget offered more of these specialized services on-site, compared to smaller staffed facilities.
VA sites that used off-site arrangements to provide these services were two to three times more likely to contract services with a non-VA facility than a VA site, according to the researchers.
"Off-site contracts allow VA facilities to expand the range of services offered, resulting in almost universal availability of specialized women's health services to VA users," Washington says.
Although these arrangements did add up to comprehensive coverage for the veterans in most cases, they "may make it more difficult to obtain needed services, depending on their proximity, ease in making appointments and ability to communicate across VA and non-VA providers," according to Washington and colleagues.
Women will make up 10 percent of the U.S. veteran population in 2010. Among women veterans who use the VA system, 42 percent depend on it as their sole source of health care.
The study was published in the March-April 2003 edition of the journal Women's Health Issues and was supported by the Department of Veterans Affairs Office of Public Health and Environmental Hazards.
FOR MORE INFORMATION
Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Interviews: Contact Dan Bruneau, VA Director of Communications at (410) 962-1800 x289 or dan.bruneau@mail.va.gov.
Women's Health Issues: Contact Carol S. Weisman at (202) 863-4989.