VA Health Care: Office of Rural Health Efforts and Recommendations for Improvement

What GAO Found

Veterans living in rural areas can face challenges that lead to disparities in access and quality of health care compared with their urban counterparts. For example, previous GAO work and research have highlighted staffing shortages and limited access to broadband internet that may affect rural veterans' access to health care. The Department of Veterans Affairs (VA) identified the Office of Rural Health, within the Veterans Health Administration (VHA), as one of the main offices responsible for increasing rural veterans' access to care. The office's mission is to improve the health and well-being of rural veterans through research, innovation, and the dissemination of best practices. To support its mission, the office provides two types of funding:

• Initiatives. Funds are used by VHA program offices to expand existing VHA services to rural veterans, such as providing transportation to medical care.
• Research. Projects are used by VA researchers to develop, test, and disseminate research in areas outlined in the office's goals and mission. The office's five resource centers, which are field-based hubs, manage a portfolio of research projects in support of the office's mission.

In a May 2023 report GAO recommended that the office require its five resource centers to communicate available research funding opportunities across VA. Each of the resource centers is responsible for identifying research projects to fund; however, GAO found the centers only communicate funding opportunities to VA researchers by word-of-mouth, rather than through a formal process. Relying on informal processes to communicate the availability of funding potentially creates a disadvantage for researchers with whom the resource center staff do not have existing relationships. VA concurred with the recommendation. As of October 2023, it reported that the office has begun taking steps to develop standard operating procedures for communicating research funding opportunities. VA anticipates developing standardized procedures by May 2024.

GAO also recommended that the Office of Rural Health develop performance goals that reflect leading practices, such as being objective and measurable. For years 2020 through 2024, the office's strategic goals are to

1. promote federal and community care solutions for rural veterans,
2. reduce rural health care workforce disparities, and
3. enrich rural veteran health research and innovation.

However, in its May 2023 report, GAO found the office had not developed performance goals that define the level of performance the office aims to achieve during a particular year. For example, while the office collects data on the number of clinicians trained through its funded initiatives and research projects, it had not defined how many clinicians should be trained each year to achieve its strategic goal of reducing health care workforce disparities. By developing performance goals that reflect leading practices, the office can determine which strategic goals may need additional focus or resources to ultimately improve rural veterans' health and well-being. VA concurred with the recommendation. As of October 2023, the office began taking steps to develop performance goals to include in its 2025 – 2029 strategic plan.

Why GAO Did This Study

In fiscal year 2022, about one-third of the 8.3 million veterans enrolled in VHA lived in a rural area. Comparatively, about one-fifth of Americans lived in a rural area. VA projects rural veterans will continue to represent a significant proportion of the nation's veterans. VA identified rural veterans as an underserved population in its strategic plan and included an objective to increase health care access for rural veterans.

VHA's Office of Rural Health was established in 2006. In fiscal year 2022, the office's budget was about $311 million, which it used to fund initiatives and research projects. That same year, the office served about 547,000 veterans, according to officials.

This statement describes GAO's recent work examining VHA's Office of Rural Health, including recommendations GAO made on (1) communicating research funding opportunities across VA and (2) developing performance goals.

This statement is based on GAO's work issued in May 2023 (GAO-23-105855). GAO also reviewed information on VHA's efforts to implement GAO's recommendations.

For more information, contact Alyssa M. Hundrup at (202) 512-7114 or hundrupa@gao.gov.