Evaluating the impact of veterans expanded care legislation: a qualitative systematic review

Abstract Background The Veterans Health Administration (VA) provides healthcare to over 9 million enrollees, and the desire to further access to healthcare for Veterans led to the passage of multiple new laws over the past decade including the Choice Act (2014) and the MISSION Act (2018), which have collectively expanded Veteran eligibility for VA-paid care delivered in community settings. This systematic review summarizes available evidence regarding patient and provider perceptions of these expanded care initiatives. Objectives To synthesize findings on (1) the attitudes and perceptions of VA patients and clinicians towards the Choice and MISSION Acts and (2) impact of this legislation on access to care. Design A qualitative systematic review as an evidence synthesis of relevant qualitative studies. Method Searches of PubMed, Google Scholar, Embase and APA PsycINFO electronic databases returned 1249 records, of which 23 met the inclusion criteria for this review using the Cochrane approach to qualitative evidence synthesis. Results The synthesis of findings reveals significant insights into the healthcare landscape for veterans. Key results include challenges faced by Veterans in navigating community care, such as complex scheduling and billing issues. Primary Care Physicians highlighted difficulties in care continuity due to administrative challenges. Positive aspects of the Choice and MISSION Acts included enhanced access to care, especially for rural veterans, although disparities persisted. Provider burnout was noted, particularly among those facing care coordination challenges. Satisfaction levels among Veterans varied, with factors like the provider-patient relationship and facility environment influencing care choices. Notably, Choice implementation led to improvements in some access respects but presented communication and scheduling challenges. Conclusion This systematic review underscores the importance of understanding healthcare access and experiences for veterans within the VA system and its programs. The findings shed light on areas that require attention, such as addressing geographic disparities and improving coordination between VA and community care providers. Policymakers, healthcare administrators, and researchers can leverage these insights to inform decision-making, enhance program efficacy, and ultimately ensure that veterans receive optimal healthcare services.