STATEMENT OF
Richard Hartman, Director
VHA Policy, Analysis and Forecasting
Before the
Senate Committee on Veterans' Affairs
July 21, 2007
*
Good afternoon, Mr. Chairman, members of the Committee and visiting members.  Thank you for the opportunity to discuss VA's ongoing efforts to provide safe, effective, efficient and compassionate health care to veterans residing in rural areas.  I am accompanied today by Mr. William Feeley, VA's Deputy Under Secretary for Health for Operations and Management.
My remarks will briefly review the national challenge presented by rural health care and VA's strategic direction and initiatives that are underway.   While I am here to present VA's national overview and direction for addressing the needs of our rural veterans, Mr. Grippen, Mr. Floyd and Mr. Underkofler are here to give you the first hand account of their implementation and experience as it is happening here in Montana and Network 19 with our veteran population.
Among the entire enrolled VA population, 39 percent were classified as rural at the end of FY 2006.  And among the entire enrolled VA population, two percent were classified as "highly rural." Highly rural refers to counties with less than seven citizens per square mile.
Researchers have studied the rural health care experience, including a number of articles that looked at VA rural healthcare.  Three studies have found that veterans living in rural areas tend to be slightly older and have slightly more physical health problems but fewer mental health conditions - as compared to suburban and urban veterans.
VA's strategic direction is to enhance non-institutional care with less dependence on large institutions.  We provide home based primary care as well as other home based programs.  We are using tele-medicine and tele-mental health to reach into the veterans' homes and into community clinics, including tribal clinics.  This allows us to evaluate and follow patients without them having to travel to large medical centers.  We are also using a special internet site, providing information to veterans in their own home, including up to date research information, access to portions of their medical records, and the ability to refill medications on-line.
To further increase access to care, VA has over 880 outpatient clinics, of which, over 700 are Community Based Outpatient Clinics (or CBOCs) located around the country.  Forty-five percent of our CBOCs are located in rural or highly rural areas.  In addition, we are expanding these efforts with the establishment of outreach clinics, such as the one announced by the Secretary that will be opening in Craig, Colorado.  There are currently twelve open outreach clinics.     
VA is focusing additional attention on the special needs of veterans who reside in rural areas.  In accordance with Section 212 of the Public Law 109-461, VA has established an Office of Rural Health. The mission of the office is to develop policies and identify and disseminate best practices and innovations to improve services to veterans who reside in rural areas.  The office is accomplishing this by coordinating delivery of current services to ensure the needs of rural veterans are being considered.  VHA is working to incorporate the unique needs of rural veterans as new programs are implemented.
In addition to our internal efforts, VA continues to look for ways to collaborate with complementary Federal efforts to address the needs of health care for rural veterans.  We have partnerships with Health and Human Services (HHS), including the Indian Health Service (IHS) and HHS's Office of Rural Health Policy, collaborating in the delivery of health care in rural communities.
Thank you for your continuing support of our veterans.  VA recognizes the importance and the challenge of service in rural areas, and we believe our current and planned efforts are addressing these concerns for our current and emerging veterans.  I will be happy to answer any questions you may have.