New Challenges Face Health Care System Treating Women Veterans

In a military health care system originally geared for men, are women veterans getting the health care they need?

The Veterans Administration is doing a lot to ensure that they do, according to the July/August Women’s Health Issues, a journal of the Jacobs Institute of Women’s Health at The George Washington University School of Public Health and Health Services.

But female veterans also say the quality of care varies from VA hospital to hospital and clinic to clinic and that the battle for services geared for women has been hard-fought.

“Women entering the military at unprecedented levels have changed forever the range of services offered,” said Elizabeth M. Yano, with the VA's Health Services Research & Development Service, who co-edited the research papers compiled in the latest edition of Women's Health Issues. The VA Women’s Health Research Network oversaw the publication.

Women’s use of military health care has doubled in the past 10 years, with females making up about 10 percent of the system’s more than 6.5 million users. A record-breaking 50 percent of women returning from Iraq and Afghanistan have enrolled for military health care.

Yano asked the Jacobs Institute to examine the medical care provided to women veterans and active-duty personnel. The resulting journal supplement compiles reports on gender differences and disparities in several areas of care and mental health. Among them: substance abuse; military sexual trauma (MST), which is assault or harassment during service; post-traumatic stress disorder (PTSD); and special populations, including homeless women veterans and those with traumatic brain injury (TBI).

Differences between men and women, for example, are reflected in these numbers—25 percent of women and 1 percent of men report military sexual trauma (MST) during routine military screening, according to Rachel Kimerling of the National Center for Post-Traumatic Stress Disorder, VA Palo Alto Health Care System.

Women with MST reported 73.8 percent satisfaction with the military's overall coordination of treatment compared to 80.4 percent for women not suffering MST.

Surprisingly, although studies show women are about twice as likely to develop PTSD as men, Kimerling said men and women veterans from the same war tend to have similar rates of PTSD.

Joy Ilem served as an Army emergency medical technician in the 1980s in Wurzburg, Germany, and now is the deputy national legislative director for Disabled American Veterans working on health policy issues for disabled veterans. 

She described her care at VA facilities as very good overall, but she said care can vary greatly among the 150 medical centers and more than 800 outpatient clinics nationwide.

In a nationwide study of more than 160,000 VA outpatients, 72.3 percent of women and 78.5 percent of men reported overall satisfaction in quality of care.

Comprehensive health care for women veterans wasn't always available.

Bay Area veteran Delphine Metcalf-Foster and her friend, Rita S. Marsden of Vallejo, remember when they had to get mammograms at non-military clinics.

Foster has used the VA health system since 1991, when her 21-year Army career ended after she suffered a heart attack serving in the first Persian Gulf War.

She recalled having to work with the San Francisco VA doctors to get a women-only combat group for PTSD therapy. Later, she had to go outside of the system for her knee replacement since the VA did not offer gender-specific prosthesis.

But Foster thinks the VA, ahead of the private sector in getting computerized, has one of the best systems for keeping and tracking medical care records.

Marsden, who turns 80 this month, was a Navy medic from 1957 to 1968, and served aboard the USS TAP Patrick in the Pacific when the Vietnam War began.

She called the VA an excellent place. “But we had to fight for everything,” she said. “When I started out, they didn’t even have stirrups—no place for a woman.”

The two serve on their congressman’s VA committee as well as with Disabled American Veterans to help women veterans get better care.

Conditions appear to be changing, the data indicates.

Last year, 1,000 VA providers were trained to treat women. All VA facilities have at least one women's specialist. The goal is getting all women veterans enrolled and providing them with one-stop shopping for services.  

By 2007, two-thirds of VA centers serving 300 or more patients had adopted gender-specific services for women, according to Dr. Donna Washington of the VA Greater Los Angeles HSR&D Center of Excellence for the Study of Healthcare Provider Behavior.

To read the research on women vets and their care in Women’s Health Issues, go to whijournal.com/supplements.

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