An examination of facilitators and barriers to care receipt among specific groups of LGBTQ+ and cisgender heterosexual Veterans

Abstract: This study examined rates and factors associated with past-year Veterans Health Administration (VHA) overall health care utilization and Department of Veterans Affairs (VA) mental health treatment among lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) and cisgender heterosexual veterans. Baseline data from a national longitudinal study of LGBTQ+ and cisgender heterosexual veteran VHA users and nonusers (N = 1,062) were used in generalized linear models to estimate the predicted prevalence of VHA health care utilization for each LGBTQ+ and cisgender subgroup, stratified by gender. Additional multivariable regressions were guided by the Andersen health services utilization model. There were no significant differences in health care utilization among women subgroups. Among male subgroups, cisgender gay men had a lower predicted prevalence of VHA utilization than cisgender heterosexual and transgender men. In both the women’s and men’s models, VHA eligibility indicators and perceived lack of service availability were associated with increased odds for any past-year utilization; higher income, difficulty understanding eligibility/benefits, and logistical barriers were associated with decreased odds. Lifetime harassment at VHA was positively associated with past-year overall VHA utilization in women’s models. LGBTQ+-specific factors explained significant variance in some models while transgender/gender-diverse-specific needs did not. These findings suggest that veterans generally need assistance navigating VHA eligibility issues and that LGBTQ+ veterans would benefit from systemic attention to provider sensitivity and availability of services focused on their needs. The high rates of harassment reported across women subgroups (19%–25%) and by transgender men (38%) warrant institution-wide action.