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Health Services Research & Development

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HERC Health Economics Seminar

External Determinants of Veterans’ VA Healthcare Utilization


by Austin Frakt, PhD ; Amresh Hanchate, Ph.D.
Seminar date: 5/18/2016

Description: In developing projections, we propose that models of VA healthcare utilization should include factors external to the VA because state Medicaid policy, local economic conditions and non-VA insurance coverage may influence VA use. Using individual-level longitudinal data on annual healthcare utilization ($) by all Veterans nationwide, we estimated change in use of VA healthcare associated with area-level changes in Medicaid eligibility, unemployment rate, housing price index, non-VA provider availability and proportion covered by employer-sponsored health insurance. While most external factors were associated with significant change in utilization, Medicaid policy, employer-sponsored coverage and housing price index had a larger role in recent years. Between 2013 and 2014, Medicaid expansion was associated with a sizable reduction in VA healthcare utilization, predominantly in the states that expanded Medicaid; this change was largely neutralized by increase in VA utilization associated with sizable reduction in employer-sponsored coverage. Target audience: VA researchers and policy-oriented staff



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