Relationship between Clinical Conditions and Use of Veterans Affairs Health Care among Medicare‐Enrolled Veterans

Abstract

Objective. To determine how reliance on Veterans Affairs (VA) for medical care among veterans enrolled in Medicare is affected by medical conditions, access, and patient characteristics. Data Sources/Study Setting. Department of Veterans Affairs. Study Design. We examined reliance on the VA for inpatient, outpatient, and overall medical care among all VA users in fiscal years 2003 and 2004 who were also enrolled in Medicare. We calculated the marginal effects of patient factors on VA reliance using fractional logistic regression; we also analyzed overall VA reliance separately for under-65 and age-651 groups. The primary focus of this analysis was the relationship between aggregated condition categories (ACCs), which represent medical conditions, and reliance on the VA. Principal Findings. Mean VA reliance was significantly higher in the under-65 population than in the age-651 group (0.800 versus 0.531). Lower differential distance to the VA, and higher VA-determined priority for health care, predicted higher VA reliance. Most individual ACCs were negatively associated with VA reliance, though substance abuse and mental health disorders were significantly associated with increased reliance on VA care. Conditions of the eyes and ears/nose/throat had positive marginal effect on VA reliance for the under 65, while diabetes was positive for age 651. Among inpatients, veterans with ACCs for mental health conditions, eye conditions, amputations, or infectious and parasitic conditions had higher likelihood of a VA hospitalization than inpatients without these conditions. Conclusions. Many dually enrolled Veterans use both Medicare and VA health care. Age, accessibility, and priority level for VA services have a clear relationship with VA reliance. Because dual use is common, coordination of care among health care settings for such patients should be a policy priority.

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

“…16 Figure 4 VA health care workers interviewed by RAND noted that lack of an affordable private insurance option is a key reason why Veterans enroll in VA. This finding is in keeping with prior studies, which have reported that Veterans seek VA care due to its low cost relative to their other coverage alternatives (Jonk et al, 2005;Nelson, Starkebaum, & Reiber, 2007;Petersen et al, 2010;Nayar et al, 2013).…”

“…Although Veterans may face similar challenges in traveling to care regardless of whether the care is provided by VA or private-sector providers (Wakefield et al, 2007), VA health care providers we interviewed noted that a long distance from a facility or concerns about transportation to the nearest facility may lead Veterans to seek alternative sources of health care. Studies of female, Medicare-eligible, and rural Veterans support this view, finding that these Veterans are less likely to seek or continue to seek care from VA if they live farther away from VA facilities (Petersen et al, 2010;Buzza et al, 2011;Liu et al, 2011;Hamilton et al, 2013;Nayar et al, 2013;Friedman et al, 2015). Similarly, Overview of Methods and Data for Access to VA Care…”

“…Unemployment and lower income status are both independently associated with an increased reliance on VA services (Jonk et al, 2005;Fillenbaum et al, 2007;Nelson, Starkebaum, & Reiber, 2007;Petersen et al, 2010), likely due in part to the demand for lower-cost health care services among unemployed and lower income Veterans.…”

Evaluating a Model to Predict Primary Care Physician-Defined Complexity in a Large Academic Primary Care Practice-Based Research Network

“…Extensive literature demonstrates a link between various diagnosisbased and prior utilization-based measures of complexity, acute care utilization, and costs. [19][20][21][22][23][29][30][31][32] Generally, these approaches use administrative claims/billing, and less commonly, electronic medical record data to create risk groupings that predict future utilization and costs. [33][34][35] More limited literature demonstrates that adding outpatient utilization information and psychosocial factors improve predictive models for acute care utilization.…”

Dual Healthcare System Use During Episodes of Acute Care Heart Failure Associated With Higher Healthcare Utilization and Mortality Risk

“…Our research team recently found significantly higher rates of ED visits for HF (adjusted rate ratio 1.15, 95% confidence interval [CI] 1.04–1.27), hospitalization for HF (adjusted rate ratio 1.4, 95% CI, 1.26–1.56), and all‐cause hospital readmission after HF hospitalization (1.46, 95% CI, 1.30–1.65) among individuals who were dual users as compared with VA‐only users 12. However, this study and most other studies of dual use to date have focused on dual use at the patient level, categorizing individuals as dual users or single system users 4, 13, 14, 15. While this approach is instructive and likely captures long‐term risk at the individual level, such analyses may separate the exposure (dual use) from short‐term outcomes of interest.…”