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Kramer BJ (VA Greater Los Angeles Healthcare System (GLAHCS)), Wang M
(VA GLAHCS), Finke B
(Indian Health Service), Saliba D
(VA GLAHCS)
Objectives:
1) Determine on a national level the extent of dual use of Indian Health Service (IHS) and Veterans Health Administration by American Indian and Alaska Native (AIAN) veterans, 2) describe characteristics of dual users and 3) identify types of medical and mental health care that are accessed in each system.
Methods:
We performed a secondary bivariate analysis of linked and merged centralized administrative data from the VHA National Patient Data Base and the IHS National Patient Information Reporting System for FY02- FY03 (n=64,746).
Results:
One-quarter of this AIAN veteran population used both the VHA and IHS, while 28% used only VHA for healthcare and 46% used only IHS. The proportion of these three user groups varied by geographic location (i.e., state). Dual users, when compared to IHS-only or VHA-only users, were similar in age (average = 55 years; age = 65 = 25%) and more likely to be female (14% v 7% and 8%, respectively). Dual users and VHA-only users had similar priority status for VHA care based on the degree and severity of their service-connected injury or illness (40.2% and 38.6%, respectively). AIAN veterans had the same top three diagnoses as other veterans who use the VHA: diabetes, hypertension, and post traumatic stress syndrome. Among dual users, care was not evenly divided between IHS and VHA. Dual users were likely to use IHS for primary care (64%) and VHA mental health (86%) and diagnostic (89%) care. Dual users generally sought treatment in either the VHA or the IHS for mental health or acute conditions; however there was considerable overlap of care for such chronic conditions as diabetes (46.7%) or hypertension (33.6%).
Implications:
VHA is an important source of healthcare for AIAN veterans who are also enrolled in IHS. Strategic planning efforts should focus on regional variation in enrollment and use of VHA. Coordination of care should be a priority to avoid potential overlaps and fragmentation of care.
Impacts:
This research informs the strategic planning processes at national and regional levels in the VHA and IHS as the agencies’ Memorandum of Understanding to share resources is implemented.
