The Department of Veterans Affairs uses the
Rural-Urban Commuting Areas (RUCA) system
to define rurality. Developed by the Department
of Agriculture (USDA) and the Department of Health
and Human Services (HHS), the RUCA system takes
into account population density, as well as how
closely a community is linked socio-economically to
larger urban centers.
The Veterans Health Administration (VHA) provides comprehensive healthcare services to approximately 8.9 million of the 22 million United States Veterans. U.S. soldiers in recent conflicts are increasingly drawn from rural areas and, therefore, rural VA users are growing proportionate to urban VA users. Youths living in the most sparsely populated zip codes are 22 percent more likely to join the Army, with an opposite trend in cities. Regionally, most enlistees come from the South (40 percent) and West (24 percent).
Prior cross-sectional and longitudinal analyses indicate that Veterans who live in rural settings have greater healthcare needs than their urban counterparts. Specifically, rural Veterans have lower health-related quality-of-life scores and experience a higher prevalence of physical illness compared to urban Veterans. While prevalence of most psychiatric disorders is lower for rural compared to urban Veterans, rural Veterans with psychiatric disorders are sicker as measured by lower health-related quality-of-life compared with urban Veterans. These difference in health-related quality-of-life scores, which equate to lower self-rated health status, among rural dwelling Veterans, are substantial, clinically meaningful and associated with increased demand for healthcare services.
Despite greater health care needs, rural Veterans are less likely to access health services for both physical or mental illness either through the VA or the private sector. In particular, rural Veterans have lower access to care for chronic conditions such as hypertension and post-traumatic stress disorder. Travel barriers including greater distance to care and lack of public transportation contribute to limited access to care for rural as compared to urban Veterans. To address these distance and access barriers, VA has invested in a full spectrum of telemedicine technologies including tele-video for provision of psychiatric services at a distance, combination telephone case management and health monitoring technologies for chronic disease care, and audio-visual telemedicine diagnostic strategies for a variety of conditions including pulmonary care, cardiology, diabetic care, dermatology, and pathology services. Studies to date suggest these distance strategies are feasible, acceptable, and cost-effective.
View the ORH Fact Sheet for more information about rural Veterans and the Office of Rural Health.
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