What is the most cost-effective delivery model for VA women’s health care that achieves patient expectations and perceptions?

Women are the fastest growing group of veterans using Department of Veterans Affairs (VA) services. In 2000, only 4% of women made up the veteran population and it is projected to grow to 18% by 2040 (Veterans Affairs, 2022). It is imperative women veterans have access to quality care, gender-appropriate services, preference for a gender-sensitive environment, access, and availability to relevant information to meet their needs in healthcare. The Veterans Health Administration (VHA) in an effort to address gender-specific care and gender-sensitive environments created Women Veteran’s Health Care in 1988 (Veteran Affairs, 2022). To date, little data is available to guide implementation of services to women veterans within Department of Veterans Affairs health care (Kimerling et al., 2015). Finally, the proposal’s goal is to highlight the necessity for women veterans to have access to quality and equity of care within the VA and community-care services without gender-bias.

 

 

 

The proposal will analyze the quality of health care women receive at the VHA based on current health care industry performance-outcome models. In addition, the proposal will assess whether gender differences exist within the VHA, informed by qualitative and quantitative data, perceptions, and experiences of women veterans. The proposal will review some of the questions that have been raised in the past about this topic and identify gaps found in previous studies in the literature.

 

The affected population, in this case, are women veterans. The U.S. Department of Veteran Affairs defines a veteran as any “person who served in active military service and who was discharged or released therefrom under conditions other than dishonorable”. The problem, in this proposal, is that some women veterans perceive they are not receiving gender-sensitive quality care within the VA health system. Women veterans experience gender-bias medical care which they perceive is not equitable to the quality-of-care male veterans receive. Gender bias creates dangers in medical care when different manifestations of disease are not considered based on sex, and patient outcomes suffer. Women veterans’ perceptions and experiences of VA health care are often related to women’s health issues and influence their decision-making about VA use (Washington et al., 2007). This influence women veterans to seek health care outside of the VA. The problem is fundamental for social work practitioners to implement intervention strategies to improve women’s access to quality and equitable care within the VA, that meet the unique needs of women with respect to gender-specific care. Also provide educational interventions to improve staff and providers gender sensitivity in VA settings, which has the potential to improve women’s comfort and engagement with VA care (Vogt et al., 2008). The paper evaluates the topic of women veteran’s health care differ from male veterans, why this is a problem, characteristics of the population, a summary of findings, and an objective proposal.

Problem

The problem, in this case, is lack of access to designated women’s health treatment settings as often as desired (Kimerling et al., 2015). Gender-sensitive care experiences has an impact on perceived access for women veterans. One in 5 women reported frequently feeling uncomfortable or out of place in their treatment setting because of their gender (Kimerling et al., 2015). These issues should be addressed with communication between the patient and provider in a shared decision-making process for health referrals and treatment planning. The feminist and empowerment theory emphasize individual and collective identity development in the context of social and gender inequality and discrimination (Lee, 2001; Mullaly, 2010). It emphasizes the importance of social, political, and economic structures that shape human societies and stresses that gender must be considered when examining the effects of oppression and domination and power and powerlessness in our society (Turner et al., 2015). Intersectionality theory will analyze how gender oppressions intersect to form interlocking patterns of injustice with race. Postmodernism perspective analyzes how prevailing ideologies affect people’s perceptions of their worlds and marginalized by privilege members of society.

Forty-seven percent of women veterans had an income below $17,720 which is 200% of the federal poverty line in a focus group for women veterans to discuss their perceptions and decision-making about using VA health care (Washington, 2007). This is significant because it limits majority of women veterans from seeking alternative healthcare outside of the VA if they are not receiving quality care. Gender has implication for health access and influence a person’s experiences of crises and emergency situations, their exposure to diseases and their access to healthcare, water, hygiene, and sanitation. This can be both a micro and macro social issue for individuals and women as a society. Limited access to quality care, medical information, and resources can put women/girls at risk for unintended pregnancies, sexually transmitted infections, cervical cancer, malnutrition, and depression. At a macro-level, gender-inequality in healthcare poses barriers for women to access health information and critical services, lack of decision-making autonomy, limited access to finances, lower literacy rates and discriminatory attitudes of healthcare providers (WHO, 2021). At a systemic level, gender bias can affect the administration of healthcare, risk factors, manifestations of illnesses, severity and frequency of diseases, health seeking behaviors, and access to care at the macro-level.

Gender-bias in VA health care comes at a cost that’s greater than monetary value, these imbalances have serious consequences and negative health outcomes for women veterans. Women have increased healthcare costs, they were charged higher insurance premiums than men for the same coverage, because of their gender. But in fact, they only used healthcare differently than males. Unequal gender representation in healthcare makes it harder for women veterans to have preference for access to female physicians. This increases cost for women veterans to seek care outside of the VA health system for community care access. Women deal with the lack of knowledge and sub-standard care for women-specific medical concerns because doctors don’t have answers to their questions, limited clinical trials and medical studies to support research-informed care. This results in missed or delayed diagnosis and improper treatment for illnesses that could result in unintended mortality rates increase. Empirical studies demonstrate that gender-bias in social institutions is bad for economic growth, shaping and influencing norms of acceptable behavior and power determines the economic choices and empowerment opportunities available for women (Ferrant et al., 2016).

Population of Interest

The population of interest, in this case, are women veterans. The characteristics and demographics according to the Women Veterans VA Decision-Making focus group are as follows: Age ranging from 26 – 83, median age is 59 years old. Ethnicity, Caucasian 55%, African American 29%, Hispanic 12%, Other 4%. College graduate 35%, employed 37%, retired 33%; annual income less than $17, 720 is 35%, insured is 72%, and VA service-connected disability 34% (Washington, 2007; Study of Barriers, 2015).

The Study of Barriers for Women Veterans to VA Health Care, reports, 273, 009 (39%) women veterans applied for benefits through the VA, 41,574 (6%) currently use (enrolled) with the VHA (2015).

Gender-bias health care affects with intersectionality, 23% of women veterans are Black/African Americans are affected because of their race and gender, they are the second largest sub-group compared to White women at 71%. Limited literature available for intersectionality theory in connection to women veterans’ experiences or the role of identity formation as a veteran due to these experiences how it impacts women veterans’ health outcomes. As the need for services for women veterans increase, understanding the impact of these intersections of identity and experiences of discrimination and oppression can be crucial in understanding the complexity of identifying as veterans and living in a society that does not see or value their experiences, as women or as veterans (Meade, 202).

Summary of findings

Numerous studies have been conducted on this topic of Do Women Veteran’s Health Care Differ from Male Veterans. Conceptual, qualitative/quantitative, mixed methods, surveys/interventions effectiveness, and program evaluations were some of the types of studies reviewed for this proposal. Kimerling et al. (2015) researched ‘Access to Mental Health Care Among Women Veterans’ using a population-based sample method of 6286 women veterans. The findings concluded that half of all women reported perceived mental health need; 84.3% of them received care, 90% used VA services, only half reported their mental health care met their needs completely. Gender-related experiences concluded lack of availability of female providers, women-only treatment settings, women-only treatment groups, and gender-related comfort.

Some questions addressed in the literature are; the impact of women’s experiences with access to female providers is, designated women’s mental health services, same-gender group treatments. Most models extend the quantification of access from observations of service utilization among perceived need for care, or unmet need, to examination of how well these services meet an individual’s needs (Nicosia, 2021). The samples were diverse between veteran women and non-veteran women, young to old populations, with different socioeconomic backgrounds. The samples that were used to assess and evaluate ease of access to care and gender-specific care needs, and perceived thoughts on quality of care comparatively with civilian healthcare outside of the VA. The literature used different research instruments to collect relevant data related to women veteran’s access to equitable healthcare, they include

questionnaire, surveys, interviews, observations, and focus groups. The use of the different instruments for measuring intended outcomes provided relevant and actionable data to capture the perceptions and experiences of women veterans.

The results and findings were congruent among the literature, most women veterans valued quality, gender appropriateness, and access when choosing health care. The perceptions and experiences with VA health care lacked those expectations aforementioned. Significant findings/recommendations, future research should be directed toward determining the most cost-effective delivery model for VA women’s health care that achieves the goals and expectation of women veterans.

The methodological limitations of studies were lack of previous studies on the topic for women veteran’s access to quality care. The sample was limited to VA primary users in an effort to investigate gender-related access, the results cannot be generalized to women veterans outside of the VA health care system, survey non-responses could have affected the representation of the sample with respect to unmeasured variables or variables not available in VA data.

Objective

The proposal provides critical information on the topic of the Veteran Affairs not providing gender-sensitive health care to women veterans. Principally, the information is fundamental and can be used as a case study for students, researchers, scholars, and any other people wishing to attain this information. Such knowledge is essential and will make an individual understand some of the approaches and measures for caring for this population. Additionally, the details of this proposal can be applied by people wishing to conduct further research regarding this topic. By raising awareness of the affects of gender-bias in veteran women’s health care will ensure training, education, program, and process improvement for care.

Social workers have the duty of caring for people in their communities. Primarily, this includes training VA staff and practitioners on effective approaches to gender-sensitive health care to women veterans. The proposal talks about the resource gaps in health care for women veterans. The duty of ethics in social work is imperative as it makes individuals aware of what should be done when caring for the women veteran population. Social justice ramifications, in this case, include the failure of the VA health care administration to meet the quality of care and access to equitable care for women veterans. It is fundamental for people to enact approaches to caring for this population considering their dedication and service to country.

In addressing this topic, I will focus on specific questions to ensure this issue is fully investigated and implementation of programs and processes are developed to reframe the perceptions and improve the experiences of women veterans in VA health care. Below is the list of questions that will be used to further evaluate this topic:
What are Women Veterans perception of Veteran Affairs Health Care system?

1. Do gender differences exist in Veterans Affairs health care? How does that affect women veteran’s care?
2. Is there gender-specific quality care offered to support women veterans based on current health care industry performance-outcome models?
3. What is the most cost-effective delivery model for VA women’s health care that achieves patient expectations and perceptions?

The research will aim at testing the specific hypotheses. Primarily, the hypothesis, in this case, is it true women veterans experience gender-bias when accessing and utilizing the VA health care. As indicated by the questions, the hypothesis in this case, will aim at understanding processes and policies that can improve perceptions and experiences of women veterans. To answer these questions, the research will evaluate and assess the hypothesis from different angles. Since this is a critical topic, the researcher will concentrate on sampling a large population using surveys and other approaches to collecting data and information. The proposal aims to discover ways to improve access to gender-sensitive health and mental care among women veterans.