Veterans' system-of-care preferences for percutaneous transluminal coronary angioplasty in a rural setting

: Context: In the Veterans Health Administration (VHA), regionalization of high‐technology health care services may influence veterans who live far from referral centers to obtain care locally, through the private sector. Purpose: To understand veterans' system‐of‐care preferences for a high‐technology regionalized service. Methods: The charts of 142 veterans who were referred for percutaneous transluminal coronay angioplasty PTCA) by their VHA cardiologists were reviewed. Findings: Fifty two percent of these veterans obtained the procedure outside the VHA system. Insurance coverage and out‐of‐pocket costs were strongly associated with veterans' obtaining PTCA outside of the VHA system; travel distance was not. Conclusions: As the VHA begins to understand veterans' use of multiple systems of care, it will be important to understand the relationship between out‐of‐pocket costs and the system of care used for high‐technology health care services.