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13. Who Will Use VA in the Future?
S Zhang, Center for Health Quality, Outcomes, and Economic Research (CHQOER); Y Shen, Center for Health Quality, Outcomes, and Economic Research (CHQOER); A Hendricks, Center for Health Quality, Outcomes, and Economic Research (CHQOER); BH Chang, Center for Health Quality, Outcomes, and Economic Research (CHQOER); L Kazis, Center for Health Quality, Outcomes, and Economic Research (CHQOER)
Objectives: To estimate the impact of insurance coverage and VA priority status on enrollees' plans to use VA as their primary source of care in the future, controlling for enrollee's socio-demographic characteristics and health status.
Methods: We used the insurance/utilization module (n=152,258) of the '1999 Large Veterans Health Survey' and defined enrollees' future plans as their self-reported use of VA in the future as "a primary source of care." We estimated the impact of insurance coverage and priority on their future plans using logistic regression, controlling for enrollees' age, health status measured by SF-36 physical and mental summary scores, among others.
Results: Overall 63.8% of enrollees plan to use VA as their primary source of care in the future. This percentage varies substantially by age, priority, different insurance coverage and other characteristics. Enrollees who are non-white, married, less educated, facing economic hardship, in worse physical and mental health status, with more diagnosed chronic diseases are more likely to plan to use VA as their primary source of care. Compared with people aged 65 and over, enrollees aged 18-49 will be less likely to use VA, while those aged 50-64 will be more likely (odds ratios are 0.78 and 1.2 respectively). Compared with low-income enrollees (VA priority category 5), only those with 50%+ service connected disabilities (priority category 1) are significantly more likely to use VA as their primary source of care. Enrollees in categories 2, 3, 6, and 7 are less likely, as are enrollees who had not yet received health care in VA as of the summer of 1999 (odds ratios decrease from 0.78 to 0.42). Compared with people having only Medicare basic A & B coverage, enrollees without any public or private insurance coverage are twice as likely to use VA (odds ratio 2.07), while patients with private insurance (whether in Medicare or not) are less likely to plan to seek their care primarily from VA (odds ratios = 0.17 and 0.21 respectively). All the above differences are significant at the P<0.0001. Of patients who have used only VA services in the past 12 or 36 months, 94 % plan to use VA as their primary source of care in the future, while 60% of patients who used only non-VA services plan to use VA only as back up. In terms of the geographic variance, the percentage of people who plan to use VA as their primary source of care varies from 71.1% for VISN 9 & 15 to 49.6% for VISN 3. Northeast VISNs (1-4,10) have the lowest percentages (49.6% to 58.2%), Southern VISNs (7-9,15,16,18) have the highest (67.8% to 71.1%).
Conclusions: There is significant variation in VA enrollees' plans to use VA as a primary source of care across age, priority groups and for patients with different insurance coverage or in different areas of the country, controlling for health status and individual characteristics.
Impact: These findings are important for predicting the future use of VA service, especially given changing insurance coverage and policy decisions concerning priority status.