Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3033 — Where Do VA Patients Obtain Transplant Care?

Author List:
Weeks WB (VA Outcomes Group, NCPS, VAQS, Dartmouth Medical School)
West AN (VA Outcomes Group, NCPS)
Murray C (VA Quality Scholars Fellowship Program)

Objectives:
To determine whether VA enrollees rely on the VA or private sector for organ transplantation, and whether proximity to regional transplant centers is associated with that choice.

Methods:
From a national combined VA/Medicare dataset (for 1999-2001) and a comprehensive New York VA/Private Sector dataset (for 1998-2000), we estimated the proportion of VA enrollees who used the VA or the private sector for kidney, liver, heart, or bone marrow transplantations. We examined patient demographics and used ZIP Codes to determine whether living in the service area of a VA Medical Center or VISN offering relevant VA transplantation services was associated with greater use of those services.

Results:
From the VA/Medicare dataset, we found that enrolled veterans 65 or older obtained 95% of kidney transplants, 90% of heart transplants, 54% of liver transplants, and 32% of bone marrow transplants in the private sector. Depending on the organ, patients who lived in the service area of a VA facility offering relevant transplant services were 5-12 times more likely to obtain transplantation in the VA system; those living in a VISN offering relevant services were 2-6 times more likely to obtain VA transplants. From the New York dataset, we found that, except for kidney transplants, a substantial proportion of veterans, both older and younger than age 65, obtained private sector transplants that were not paid for by Medicare. From New York data, we projected that enrolled veterans obtained 96% of 2496 kidney transplants, 95% of 642 heart transplants, 77% of 915 liver transplants, and 55% of 832 bone marrow transplants in the private sector, nationally.

Implications:
The VA service population obtains virtually all kidney and heart transplants, and a majority of liver and bone marrow transplants, in the private sector. VA transplant centers that intend to meet national needs are much more likely to serve local clients.

Impacts:
VA should consider outsourcing health care services for which minimum volume standards are difficult to meet and service area boundaries appear to restrict access to regional VA care. Research that relies on the VA/Medicare dataset will substantially underestimate younger VA patients’ private sector usage of most transplantation services.