# Utilization and Health Outcomes for Veterans with Expanded Health Care Access 

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2020 · —

## Abstract

Background: Improving access to high-quality care is a top priority for VHA. However, access is difficult to
measure, especially in the ever-changing U.S. health care landscape. VHA currently focuses on perceived
satisfaction measured from survey questions, or wait times measured with administrative data. The wait time
metric has received considerable focus in both the Choice and MISSION Acts, yet experts recognize that wait
times are imperfect; they are not only challenging to interpret, but they are rarely available from community
providers, hindering any VHA to non-VA comparisons. VHA leaders tasked with implementing the Choice and
MISSION Acts desire better evidence-based access measures so they can evaluate their program’s impact.
Our inability to measure access threatens the future of VHA as a health care provider. Without new metrics
that track gaps or improvements in access, VHA is likely to invest in the wrong initiatives, fueling critics who will
argue that privatization will fix the programs Significance/Impact: Our objective is to develop new measures
of access. These new measures will provide causal information on gaps in VHA services, while also showing
the potential impact that expanded access would have on Veterans’ health. Our study leverages natural
experiments in the form of arbitrary administrative rules that enable Veterans to access care outside VHA in
the forms of Medicare and VA Community Care (VACC). Veterans close to the rule thresholds are similar, yet
some gain access based on the rule, while the others do not. We can leverage this information to understand
how this added access changes health care utilization and health outcomes. Our results will be useful to
national and local VHA leaders as they grapple with how to best improve access with a limited budget.
Innovation: It is not feasible to perform a large-scale randomized clinical trial to find the effect of access on
utilization and health outcomes. Correlational studies will miss important confounders, and as everyone knows
correlation does not equal causation, which is what VHA leaders need most. Instead, we apply novel
econometric techniques to take advantage of natural experiments and find the causal effects of increasing
access. The results from this approach can then be used as a measure of access for both VHA and non-VA
care. This is directly aligned with HSR&D's priorities on access to care, research related to the MISSION Act,
and advancing health services research methods across conditions or care settings. Specific Aims: Aim 1:
Find the causal impact of Medicare eligibility on Veteran utilization and health, and identify procedures and
diagnosis groups that are most affected. Aim 2: Find the causal impact of VACC on Veteran utilization and
health, and find the procedures and diagnoses most affected. Aim 3: Identify subgroup analyses that would
give crucial information to VHA leaders. Methodology: In Aims 1 and 2, we will apply an econometric
technique c...

## Key facts

- **NIH application ID:** 10070234
- **Project number:** 1I01HX003106-01A1
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** TODD H WAGNER
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-07-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10070234

## Citation

> US National Institutes of Health, RePORTER application 10070234, Utilization and Health Outcomes for Veterans with Expanded Health Care Access  (1I01HX003106-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10070234. Licensed CC0.

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