ORIGINAL ARTICLE Utilization of Travel Reimbursement in the Veterans Health Administration Richard E. Nelson, PhD; 1,2 Bret Hicken, PhD; 1 Beilei Cai, PhD; 3 Arati Dahal, PhD; 3 Alan West, PhD; 4 & Randall Rupper, MD, MPH 1,2 1 Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah 2 University of Utah School of Medicine, Salt Lake City, Utah 3 University of Utah College of Pharmacy, Salt Lake City, Utah 4 Veterans Affairs White River Junction Health Care System, White River Junction, Vermont Funding for this study came from the Veterans Health Administration Office of Rural Health (Drs. Nelson, Hicken, West, and Rupper) and received support from the National Institutes of Health and National Cancer Institute grant KM1CA156723 (Dr. Nelson). Acknowledgments: The authors would like to acknowledge Kristin Knippenberg who assisted with manuscript writing. For further information, contact: Richard E. Nelson, PhD, George E. Whalen Department of Veterans Affairs Medical Center, 500 Foothill Drive, GRECC-182, Salt Lake City, UT 84148; e-mail: richard.nelson@utah.edu. doi: 10.1111/jrh.12040 Abstract Purpose: To improve access to care, the Veterans Health Administration (VHA) increased its patient travel reimbursement rate from 11 to 28.5 cents per mile on February 1, 2008, and again to 41.5 cents per mile on November 17, 2008. We identified characteristics of veterans more likely to receive travel reimbursements and evaluated the impact of these increases on utilization of the benefit. Methods: We examined the likelihood of receiving any reimbursement, number of reimbursements, and dollar amount of reimbursements for VHA patients before and after both reimbursement rate increases. Because of our data’s longitudinal nature, we used multivariable generalized estimating equa- tion models for analysis. Rurality and categorical distance from the nearest VHA facility were examined in separate regressions. Findings: Our cohort contained 214,376 veterans. During the study period, the average number of reimbursements per veteran was higher for rural pa- tients compared to urban patients, and for those living 50-75 miles from the nearest VHA facility compared to those living closer. Higher reimbursement rates led to more veterans obtaining reimbursement regardless of urban-rural residence or distance traveled to the nearest VHA facility. However, after the rate increases, urban veterans and veterans living <50 miles from the near- est VHA facility increased their travel reimbursement utilization slightly more than other patients. Conclusions: Our findings suggest an inverted U-shaped relationship be- tween veterans’ utilization of the VHA travel reimbursement benefit and travel distance. Both urban and rural veterans responded in roughly equal manner to changes to this benefit. Key words access to care, program evaluation, rural, travel reimbursement, veterans. Travel distance can be a substantial barrier to accessing health care, particularly for those living in rural areas. 1 Because much of the specialty, high-tech, or inpatient (acute or tertiary) care provided in the Veterans Health Administration (VHA) is located in urban centers, rural veterans typically must travel longer distances to obtain it. 2,3 Several studies have shown that greater travel bur- den significantly reduces veterans’ use of VHA care. 4-7 Rural areas also have fewer non-VHA primary care and specialty care providers per resident than urban areas. 8 Reduced access to VHA and non-VHA providers has led to disparities between rural and urban individuals in a 128 The Journal of Rural Health 30 (2014) 128–138 c  2013 National Rural Health Association