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151. The Impact of Income, Age, Health Status and Distance to VA Facilities on Medicare HMO Enrollment by Elderly VA Using and Non-using Veterans

RO Morgan, Houston Center for Quality of Care and Utilization Studies, Houston VAMC; BA Virnig, University of Minnesota; I Huang, Houston Center for Quality of Care and Utilization Studies, Houston VAMC; CA DeVito, Miami VA Medical Center

Objectives: Reductions in benefits and/or increases in out-of-pocket expenses resulting from Balanced Budget Act (BBA) mandated changes in Medicare may influence Medicare HMO enrolled veterans, particularly individuals with lower incomes, to seek VA care. Unfortunately, there is little information on how the Medicare HMO enrolled VA users differ from HMO enrolled veterans who do not currently use the VA system. Further, it is unclear whether being a user of the VA system influences a veteranís likelihood of enrolling in a Medicare HMO, and/or whether HMO enrollment is related to veteransí income level, age, health status, or distance from VA facilities. Without this basic information, it is difficult to anticipate how changes in Medicare managed care policy might affect the VA system. The objectives of these analyses are to examine: 1) Medicare HMO enrollment among veterans who use the VA compared to HMO enrollment among veterans who do not; and 2) whether HMO enrollees differ from non-enrollees in terms of specific characteristics known to impact use of the VA system.

Methods: Data were obtained from the South Florida Health and Health Services Use Survey conducted in early 1999. Data used here are for the 683 male VA users and 483 male veteran "non-users" who completed the survey. "Non-users" were veterans with no VA use in the prior five years. Contingency table analyses and logistic and linear regression models were used to examine factors associated with enrollment in an HMO.

Results: The overall HMO enrollment rate was high (43%). Low income VA users (< $25,000/year) were less likely to belong to an HMO than were low income non-users, however, there was little difference in HMO enrollment between higher income VA users and non-users (VA user status by income interaction, p <= .01). HMO enrollees reported fewer health limitations than non-enrollees (p <= .03), with low income, non HMO-enrolled VA users reporting the most limitations. The percent of respondents reporting service-related disabilities differed between VA users and non-users (p <= .001), but was not related to HMO enrollment. Surprisingly, distance from VA facilities had a significant inverse relationship to HMO enrollment (p <= .001).

Conclusions: HMO enrollment is high among Medicare eligible, South Florida veterans. However, for lower income Medicare eligible veterans, being a VA user is inversely related to the likelihood of HMO enrollment. Among VA users, HMO enrollees rate themselves as having fewer health limitations than non-enrollees. There are no differences between HMO-enrolled and FFS-enrolled VA non-users in terms of self-rated health limitations. Contrary to expectations, distance from VA facilities is inversely related to HMO enrollment.

Impact: Use of the VA system appears to reduce the incentive to enroll in Medicare HMOs for lower income veterans and veterans with greater health care needs, but does not appear to impact rates of HMO enrollment for higher income VA users. Thus, use of the VA appears to influence participation in Medicare HMOs among the group of veterans most likely to be affected by changes in out-of-pocket expenses. Further research is needed in order to determine how changes in Medicare will impact use of the VA system.