Veterans Rural Health Resource Center - Eastern Region, Department of Veterans Affairs, White River Junction, Vermont, and Togus, Maine, USA.
J Rural Health. 2010 Fall;26(4):301-9. doi: 10.1111/j.1748-0361.2010.00298.x.
The Veterans Health Administration (VHA) devised an algorithm to classify veterans as Urban, Rural, or Highly Rural residents. To understand the policy implications of the VHA scheme, we compared its categories to 3 Office of Management and Budget (OMB) and 4 Rural-Urban Commuting Area (RUCA) geographical categories.
Using residence information for VHA health care enrollees, we compared urban-rural classifications under the VHA, OMB, and RUCA schemes; the distributions of rural enrollees across VHA health care networks (Veterans Integrated Service Networks [VISNs]); and how each scheme indicates whether VHA standards for travel time to care are met for the most rural veterans.
VHA's Highly Rural and Urban categories are much smaller than the most rural or most urban categories in the other schemes, while its Rural category is much larger than their intermediate categories. Most Highly Rural veterans live in VISNs serving the Rocky Mountains and Alaska. Veterans defined as the most rural by RUCA or OMB are distributed more evenly across most VISNs. Nearly all urban enrollees live within VHA standards for travel time to access VHA care; so do most enrollees defined by RUCA or OMB as the most rural. Only half of Highly Rural enrollees, however, live within an hour of primary care, and 70% must travel more than 2 hours to acute care or 4 hours to tertiary care.
VHA's Rural category is very large and broadly dispersed; policy makers should supplement analyses of Rural veterans' health care needs with more detailed breakdowns. Most of VHA's Highly Rural enrollees live in the western United States where distances to care are great and alternative delivery systems may be needed.
退伍军人健康管理局（VHA）制定了一种算法，将退伍军人分为城市、农村或高度农村居民。为了了解 VHA 计划的政策影响，我们将其类别与 3 个管理和预算办公室（OMB）和 4 个农村-城市通勤区（RUCA）地理类别进行了比较。
使用 VHA 医疗保健参保人员的居住信息，我们比较了 VHA、OMB 和 RUCA 计划下的城乡分类；农村参保人员在 VHA 医疗保健网络（退伍军人综合服务网络 [VISN]）中的分布；以及每个计划如何表明最农村退伍军人是否符合 VHA 护理时间旅行标准。
VHA 的高度农村和城市类别比其他计划中最农村或最城市类别小得多，而其农村类别比它们的中间类别大得多。大多数高度农村退伍军人居住在为落基山脉和阿拉斯加服务的 VISN 中。根据 RUCA 或 OMB 定义为最农村的退伍军人分布在大多数 VISN 中更为均匀。几乎所有城市参保人员都在 VHA 护理时间旅行标准内居住；RUCA 或 OMB 定义为最农村的参保人员也是如此。然而，只有一半的高度农村参保人员居住在初级保健 1 小时内，70%的人必须旅行超过 2 小时才能接受急性护理，或 4 小时才能接受三级护理。
VHA 的农村类别非常大且分布广泛；政策制定者应通过更详细的细分来补充对农村退伍军人医疗保健需求的分析。VHA 的大多数高度农村参保人员居住在美国西部，那里的距离很远，可能需要替代的交付系统。
