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HSR&D 2004 National Meeting Abstracts


1003. Patterns of VA and Medicare Dual Use Among Veterans
Min-Woong Sohn, PhD, VA Information Resource Center and Midwest Center for Health Services and Policy Research, D Hynes, VA Information Resource Center and Midwest Center for Health Services and Policy Research, L Kok, VA Information Resource Center, K Koelling, VA Information Resource Center, N Arnold, VA Information Resource Center, LM Manheim, Northwestern University, F Weaver, Midwest Center for Health Services and Policy Research

Objectives: Evaluating whether veterans’ health care needs are being met requires information about the full spectrum of health services use, including Medicare data for elderly veterans. We identified and studied a cohort of 2.6 million veterans who were dually eligible for VA and Medicare in 1999.

Methods: Using linked demographic, health care utilization and claims data across the two systems of care, we examined factors predictive of the healthcare system veterans’ used. We performed multivariable regression analyses, including disease severity/risk category determined by Hierarchical Condition Categories (HCC).

Results: 83.7% were enrolled in Medicare fee for service with no group health enrollment; 21.9% used only VA services, 30.3% used only Medicare services; 42.6% used both VA and Medicare services. Patients with a high VA priority level, who were black, or who lived less than 10 miles from a VA inpatient facility were more likely to use VA exclusively, whereas blacks with low incomes were 19% more likely to be a dual user. Patients with increasing risk (indicating worse health status) were most likely to use both systems of care.

Conclusions: Veterans with higher risk scores tended to use Medicare services more, but the sickest veterans used both Medicare and VA services.

Impact: Elderly veterans with worse health status and low income may benefit most from improvements in continuity of care; however, they are most likely to receive some care outside VA. Future research should examine whether coordination of care between VA and Medicare providers might improve patient outcomes.