The House Veterans’ Affairs Subcommittee on Health held an October 2 hearing to discuss the status of women’s health care programs at the Department of Veterans’ Affairs (VA).
The subcommittee heard testimony from Rep. Heather Wilson (R-NM), the only woman veteran in Congress. She gave her perspective on health care for women veterans, saying, “Women veterans are the fastest growing specialty group in the VA health care system,” adding, “Recent statistics show that women comprise 20% of all active duty and about 15% of reservists. We need to be sure that the system is able to meet the ever-changing needs for all veterans.” She cited the need for an expanded formulary of medicines for women veterans, preventive health care, and ob-gyn care.
Dr. Robert Roswell, Under Secretary for Health at the VA, detailed the department’s activities with respect to health care programs for women veterans. Noting the “unique demographics” of women veterans, Dr. Roswell said, “Over 50 percent of the women seeking care in the VA are under 45, compared to only 15 percent of men.” Women also make up roughly 4.5 percent of the 4.3 million veterans who use the VA health care system; over the next ten years that percentage is expected to increase to 10 percent.
In providing utilization statistics, Dr. Roswell told the subcommittee that 152,094 women veterans were seen as outpatients in 2000, and 12,955 were seen as inpatients. Additionally, 14,790 Pap smears, 17,209 screening mammograms, and 21,268 diagnostic mammograms were performed in 2001.
However, Dr. Roswell noted several limitations to the care provided through the VA, particularly with respect to newborn care. “VA facilities do not have the ability to care for newborns, and the VA does not have authority to pay for the care of newborns,” he said, adding that obstetrical care is provided for the mother, but care for newborns is excluded from VA coverage. Additionally, Dr. Roswell noted that “traditional VA homeless programs cannot accommodate children, necessitating community partnerships with family and child agencies and with women’s social and support networks to provide a seamless continuum of care.”
In discussing the use of contract care to meet the needs of veterans, Dr. Roswell said, “The balance of appropriate treatment, access to community and family support, and safety and privacy must be achieved. Sometimes this is best achieved by contract care.” He pointed to gender-specific services, such as mammography, as an example. “Where the volume of cases is not adequate to assure the clinical competency of an in-house program, the VA is moving toward contract or fee-basis care.”
Joy Ilem of the Disabled American Veterans disagreed about the impact of contract care on women veterans. Noting that the VA has undergone organizational changes in the way it delivers health care, Ms. Ilem said that while “the advent of community-based outpatient clinics made access to VA health care more accessible for all veterans…,” the restructuring has led to the “discontinuation of several ‘dedicated’ women’s health clinics and a growing trend to reintegrate women veterans into primary care clinics.”
She quoted a 2000 VA report, The Health Status of Women Veterans Using Department of Veterans Affairs Ambulatory Care Services, which said that the dismantling of women’s health clinics “further reduces the ratio of women to men in any one practitioner’s caseload, making it even more unlikely that the clinician will gain the clinical exposure necessary to develop and maintain expertise in women’s health.”
Additionally, Ms. Ilem said that women veterans “continue to express concern about privacy and safety issues at some VA facilities.” Further, women veterans “still frequently complain about a lack of sensitivity by health care providers to their military experiences and to their specific health care needs.”
Irene Trotwell-Harris of the Center for Women Veterans at the VA discussed the department’s responsiveness to recommendations issued by the VA Advisory Committee on Women Veterans. The Advisory Committee issued reports in 2000 and 2002, each making a variety of recommendations pertaining to outreach, sexual trauma counseling and care, women veteran coordinators, health care, staff education, employment of women veterans in the federal government, strategic planning, and homeless women veterans. She noted that of the 25 recommendations made in 2000, 7 have been implemented, and 18 are in the process of being implemented.
Marsha Four of the Advisory Committee on Women Veterans said that the VA has eight Comprehensive Women’s Health Centers (CWHCs). Stating that four of the centers were given their designation 20 years ago, Ms. Four said, “Perhaps, it is time to reassess them and ensure there is adherence to the criteria of care that sets them aside as Comprehensive Centers.” Additionally, the VA annually selects Centers of Excellence in Women’s Health Care, and six such centers were selected this year.
Ms. Four stressed the importance of outcomes research. “You need outcomes…measurable evaluations of programs,” she said, adding, “These outcomes justify the dollars spent, the staff assigned, and the contracts formed or expanded.”
Carole Turner of the Women Veterans Health Program praised the CWHCs, noting that the centers provide “one-stop shopping” for women veterans, adding that over half of VA medical centers have a separate women’s health clinic, two-thirds of which were established since 1995. She also discussed the Women Veterans Health Program, saying that it “operates through a network of field-based Deputy Field Directors who provide needed regional leadership, guidance, and support to network and medical center leaders and facility-based Women Veterans Coordinators.”
Other witnesses advocated making the sexual trauma counseling and care program permanent and removing certain eligibility restrictions for reservists. Additionally, witnesses advocated the importance of providing privacy for female patients at VA hospitals and medical clinics, ensuring appropriate mental health treatment for women veterans, addressing the needs of homeless women veterans, and removing barriers for women seeking care through the VA.
