The Senate Committee on Veterans' Affairs recently held a hearing on veterans' health care in rural areas. Rural access to care is a continuing concern for veterans' health. In particular, as Senator Daniel Akaka (D-HI) said in his opening statement, rural settings are "some of the most difficult for VA, and other government agencies, to deliver care." One of the solutions highlighted in the hearing testimony was using telemedicine to expand access.

In the first hearing panel Adrian Atizado, assistant national legislative director of Disabled American Veterans, explained the problems still facing disabled vets in rural areas. Only 10 percent of physicians practice in rural areas. Access to mental health care to alleviate stress, depression, anxiety and suicide remains a major concern, as well as the pronounced stigma in seeking mental health care. A large portion of elderly vets live in rural areas, with a growing need for acute and long-term care. Disparities exist between the health of rural and urban veterans. Forty percent of Department of Veterans Affairs (VA) health care users reside in rural and highly rural areas. Atizado suggested improvements increasing beneficiaries' travel mileage reimbursement allowance; more use of telemedicine; and more outreach clinics and rural health coordination at the grassroots level.

James F. Ahrens, chairman of the Veterans Rural Health Advisory Committee, testified about an increasing need for delivery of physical and mental health services to local access points for the rural veteran. Ahrens said the VA needs to explore and develop innovative ways to deliver these services. Ahrens too offered several options in facilitating delivery of care, including enhancement of van transportation networks; utilizing more telemedicine; and expanded health care services (including mental health services) in the rural areas.

Some issues specific to Alaska were discussed in the second panel. Brigadier Gen. Deborah McManus, assistant adjutant general, explained that veterans will likely seek some type of mental health treatment during the first year home. She pointed out unresolved emotional problems resulting from combat can be very detrimental to a small and remote Alaska community. She also noted that lack of access to a VA facility will lead rural Alaska Native veterans to utilize the Alaska Tribal Health System.

McManus said progress was being made on the rural front, including telemedicine and teleradiology capabilities at 235 sites around the state, along with a multi-year home telehealth monitoring project through the Alaska Native Tribal Healthcare Consortium. In addition, programs have been implemented, including a VA Tribal Veterans Representative Program to train tribal representatives on VA policies; a VA education program for the Alaska Tribal Health Organizations on VA eligibility and clinical information regarding Post Traumatic Stress Disorder; vet centers participation in outreach services; and coordination of access to care through flexible case management services.

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