Varied geographical increases in the rural Veteran population

Objectives: The Veterans Health Administration's (VHA) Office of Rural Health (ORH) was established in 2006 to improve access and quality of care for rural Veterans. Identifying geographic trends in enrollment and use is essential to craft effective policy and programs. Methods: VHA designates each enrollee as Urban, Rural, or Highly Rural based upon residence. We analyzed enrollment and utilization data for each of VHA's 21 Veterans Integrated Service Networks (VISNs) over a recent four-year period (FY2006 – FY2009) to assess changes in each VISN's proportion of rural Veterans. VISNs with a majority of “Rurals” or “Urbans” were categorized as such; additionally, those with substantial proportions of “Highly Rurals” were categorized as “Rural/Highly Rural” or “Urban/Highly Rural.” Results: Two VISNs, in the Midwest, are Rural/Highly Rural, while four VISNs, in the West, are Urban/Highly Rural; two VISNs in the South and one in upstate New York are Rural. During the four-year interval, a mid-Atlantic VISN also increased rural enrollments enough to change from Urban to Rural. Nationwide, the proportions of enrollees or active users who were rural residents (Rural or Highly Rural) increased 8.6% and 8.5%, respectively, over the four years. Increases occurred in every VISN, though their magnitudes varied considerably. The Rural/Highly Rural VISNs had the smallest increase while most of the Urban VISNs experienced the greatest increase in rural enrollees and users. Implications: Policy makers and VISN directors should consider trends toward increasing rural enrollment to direct resources where they are most needed.