Racial Difference in the Use of VA Health Services

Published: 2015


We study the factors that affect the utilization of health care services administered by the Department of Veterans Affairs (VA) and its racial differences. Due to data limitation, previous research in this regard mostly only focuses on veterans who are VA users or at least eligible for VA services. We fill in the gap in literature with a random sample of veterans 51 and older from the Health and Retirement Study. We find that, among all veterans, those who are black and less healthy are more likely to use VA health services. These factors, nevertheless, are no longer statistically significant after the sample is restricted to veterans who are eligible for VA services. We also find that VA health services and services provided through other channels are at least partial substitutes: VA usage drops when a veteran becomes age eligible for Medicare or when a veteran has health insurance coverage through employment. This drop in usage holds not only among all veterans, but also among veterans eligible for VA services. Finally, perception about the quality of services delivered in VA versus non-VA facilities strongly predicts VA services usage. Those who have favorable views toward VA use VA services more, and the results from variance decomposition suggests a majority part of the racial difference in VA usage can be attributed to the racial difference in such perception.

Key Findings

    • Veterans who are more than 65 years old or who have health insurance coverage through employment are less likely to use VA services.
    • The perception regarding quality of services delivered in VA versus non-VA facilities also strongly affects VA usage.
    • Black veterans tend to have more favorable views about VA, and a sizable portion of racial difference in usage can be attributed to the racial difference in perception.
    • We show that the health care services delivered in VA are at least partially substituted by services obtained in other channels, and attitudinal factors play important roles in usage.
    • Our findings provide insights to estimate the future demand for VA services and to improve the racial disparity in utilization.


Fang, Chichun, Kenneth Langa, Helen Levy, and David Weir. 2015. "Racial Difference in the Use of VA Health Services." Ann Arbor, MI. University of Michigan Retirement Research Center (MRRC) Working Paper, WP 2015-334. https://mrdrc.isr.umich.edu/publications/papers/pdf/wp334.pdf