3057 — Where do Women Veterans Get their Inpatient Care?
Mooney SE (VA Quality Scholars) , Weeks WB
(VA Outcomes Group REAP)
Older male veterans receive care from both the VA and private sector. Less is known, however, about where female veterans obtain care. In this study we explore women veterans' use of VA and private sector inpatient services.
We performed a retrospective study of 11,684 female veterans who lived in ZIP Code defined hospital referral regions that were within New York State. We linked VA and New York Department of Health discharge datasets, identified each woman’s first admission between 1998 and 2000, and used DRG codes to determine which inpatient services were used in which system of care. We limited our analysis to the 10 most frequent Major Diagnostic Categories (MDCs) and examined patient characteristics and resource utilization by system of care. Additionally, payment sources for young veterans using the private sector were determined.
During the study period, 718 women had 1,268 admissions to VA hospitals and 904 women had 1,645 admissions to private sector hospitals. Women who used the VA were younger (mean age 54 versus 60, p<0.001), more likely to be service connected (38% vs. 24%, p<0.001), African American (25% vs. 13%, p<0.001), and urban dwelling (81% vs. 75%, p<0.01). Women veterans were significantly more reliant on the VA system for psychiatric (OR for admission 3.48, 95%CI 2.09-5.78), alcohol (OR 2.30, 95%CI 1.72-3.07), and skin/breast (OR 1.82, 95%CI 1.10-3.00) related admissions. For every MDC examined, patients at VA hospitals had longer mean lengths of stay. Among younger VA eligible women (age<65) using the private sector for hospitalization, 58% used private insurance to pay for their stay, while 14% used Medicaid, 14% used Medicare, and 8% did not have insurance coverage.
In New York, female veterans admitted to VA hospitals differed from women admitted to private hospitals by patient characteristics, admission reason, and admission resource consumption. A substantial proportion of younger women who used the private sector were reliant on other government agencies (Medicaid or Medicare) or out-of-pocket payments for their inpatient care.
VA may be able to improve inpatient efficiency for women. Coordination of care across federal agencies may maximize female veterans’ access to care.