BACKGROUND/RATIONALE:
As the US population ages and federal health care spending grows rapidly, VA must optimize the use of resources available to treat veterans. VA should understand how veterans' reliance on VA care relates to their access, both physical and financial, to non-VA care options, and how the health services utilization of the many Vietnam-era VA patients who are aging into Medicare eligibility may soon shift based on access changes. Prior research has shown, for example, that rural VA patients have worse health and less access to VA care than their urban counterparts and that rural veterans with Medicare use more non-VA care. Studies of survey data, such as the 1999 Large Health Survey, have shown that most VA enrollees have other health care coverage and use it, but actual utilization rates and expenditures have not been assessed. Nor have there been comparisons with non-veterans or veterans not in VA care, so that judgments about the relative costs and access problems of VA patients remain inadequately informed.

OBJECTIVE(S):
To enhance VA's resource allocation decisions, we will analyze survey data to compare VA patients, other veterans, and non-veterans on health care utilization and costs in several service categories. Analyses will address the extent to which VA serves those veterans with the greatest health or financial needs, and how insurance coverage, particularly Medicare, influences veterans' use of care, VA or other, in the context of care availability, health status, and age. We will assess whether veterans living beyond metropolitan statistical areas (MSAs) rely less on VA and more on other care systems, or receive less care overall, and whether degree of reliance differs for those who have Medicare or other coverage. With time-series analyses, we will assess changes in market penetration and reliance on VA care since the 1996 restructuring, and project future trends.

METHODS:
We will analyze publicly available person-level utilization and expenditures data from the Medical Expenditure Panel Survey (MEPS; www.meps.ahrq.gov) from 1996 through 2002. MEPS samples the non-institutionalized civilian population annually; males 18 or older in this seven-year dataset include 8,124 veterans and 27,272 non-veterans. We will compare VA patients, other veterans, and non-veterans with respect to socioeconomic status, health needs, visits and hospitalizations, costs to different payment sources, and perceived access and quality of care, controlling for demographics and health status. Access issues also will be addressed with comparisons of MSA and non-MSA residents, testing for interactions with insurance coverage and age (particularly the under versus over 65 distinction). Results will include weighted population estimates of annual utilization in major categories of care (inpatient, outpatient, emergency room, office-based, and pharmacy) and by major health condition or procedure, with expenditures broken down by source of payment and the respondent's gender, age category, veteran status, VA patient status, and residence (MSA or non-MSA).

FINDINGS/RESULTS:
To date, we have one paper submitted for publication which compares MEPS information on the payers for veterans' private sector hospitalizations with information derived from other data sources, describing particular advantages and disadvantages of MEPS.

IMPACT:
Understanding how insurance coverage interacts with age, residence, health status, and other factors to influence veterans' choices of whether and where to seek care will inform future resource allocation decisions and may suggest financing innovations to minimize total federal expenditures.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Weeks WB, West AN, Rosen AK, Bagian JP. Comparing measures of patient safety for inpatient care provided to veterans within and outside the VA system in New York. Quality & Safety in Health Care. 2008 Feb 1; 17(1):58-64. [view]
2. Ogrinc G, West A, Eliassen MS, Liuw S, Schiffman J, Cochran N. Integrating practice-based learning and improvement into medical student learning: evaluating complex curricular innovations. Teaching and learning in medicine. 2007 Jul 1; 19(3):221-9. [view]
3. Weeks WB, West AN, Wallace AE, Lee RE, Goodman DC, Dimick JB, Bagian JP. Reducing avoidable deaths among veterans: directing private-sector surgical care to high-performance hospitals. American journal of public health. 2007 Dec 1; 97(12):2186-92. [view]
4. Wallace AE, West AN, Booth BM, Weeks WB. Unintended consequences of regionalizing specialized VA addiction services. Psychiatric services (Washington, D.C.). 2007 May 1; 58(5):668-74. [view]
5. Weeks WB, West AN. Where do veterans health administration patients obtain heart, liver, and kidney transplants? Military medicine. 2007 Nov 1; 172(11):1154-9. [view]
6. West AN, Weeks WB. Who pays when VA users are hospitalized in the private sector? Evidence from three data sources. Medical care. 2007 Oct 1; 45(10):1003-7. [view]

Conference Presentations

1. West N, Weeks B, Bagian P. AHRQ's patient safety indicators in nine years of VA inpatient data: Low reliability limits their use as performance measures. Poster session presented at: VA HSR&D National Meeting; 2007 Feb 22; Arlington, VA. [view]
2. West N, Weeks B. Comparing three datasets on payers for the private sector inpatient care of VA patients. Poster session presented at: American Public Health Association Annual Meeting and Exposition; 2007 Nov 3; Washington, DC. [view]
3. Wallace E, West N, Booth M, Weeks B. Distance as a barrier to addiction treatment for rural and urban veterans. Poster session presented at: VA HSR&D National Meeting; 2007 Feb 21; Arlington, VA. [view]
4. Wallace AE, Booth BM, Weeks WB, West AN. Distance as a barrier to addiction treatment for rural and urban veterans in the regionalized VA system. Poster session presented at: National Rural Health Association Annual Meeting; 2007 May 17; Anchorage, AK. [view]
5. Nyweide J, Anthony L, West N, Weeks B, Fisher S. How large are primary care medical groups in the United States? A descriptive analysis. Poster session presented at: National Research Service Award Trainees Research Annual Conference; 2007 Jun 2; Orlando, FL. [view]
6. Wallace E, Lee, West N, Weeks B. Longitudinal differences in health status and utilization when comparing rural and urban veterans. Paper presented at: American Public Health Association Annual Meeting and Exposition; 2007 Nov 3; Washington, DC. [view]
7. West N, Wallace E, Weeks B. Urban-rural inequities in access to inpatient PTSD treatment in the VA healthcare system. Poster session presented at: National Rural Health Association Annual Meeting; 2007 May 17; Anchorage, AK. [view]
8. West N, Weeks B. Urban-rural inequities in the quality of hospitals where older veterans receive high-risk surgeries. Poster session presented at: National Rural Health Association Annual Meeting; 2007 May 17; Anchorage, AK. [view]
9. Weeks B, West N, Lee, Wallace E. VA Can improve older enrollees' outcomes by directing public health sector care to high performance hospitals. Paper presented at: American Public Health Association Annual Meeting and Exposition; 2007 Nov 3; Washington, DC. [view]

DRA: Health Systems
DRE: none
Keywords: Cost, Research measure, VA/non-VA comparisons
MeSH Terms: none