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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1069 — Relationship between Local Unemployment and Use of Veterans Affairs Healthcare Services in the United States

Wong ES, and Liu CF, HSR&D Northwest Center for Outcomes Research in Older Adults, VAPSHCS;

Economic business-cycle conditions, which include unemployment, are intertwined with individual labor market decisions, access to healthcare, healthcare utilization and expenditures, and health outcomes. This study examines the relationship between county-level unemployment rates and the probability of utilizing Veterans Affairs (VA) healthcare services.

Using data from the Behavioral Risk Factor Surveillance System, we identified a representative sample of Veterans for the period 2000-2004. Data were linked to the Area Resource File and the average unemployment rate over 12 months in the county of residence was computed for all respondents. VA health service utilization was defined as whether Veterans received all, some, or no care from VA. We used hierarchical ordered logistic regression to address unobserved state and county random effects, while adjusting for respondent demographics, behavioral characteristics, and health status.

Among 73,964 Veterans, 7.9% reported receiving all care, 9.5% received some care, and 82.6% received no care from VA. The mean unemployment rate for Veterans receiving all, some, and no care was 5.42%, 5.32%, and 5.23%, respectively. After covariate adjustment, a unit increase in the unemployment rate in a Veteran’s county of residence was associated with an increase in the probability of receiving all care from VA for Veterans over 65 years old (0.7%, p = 0.054) and under 65 years old (0.2%, p = 0.034). The unemployment rate was also associated with a decrease in the probability of receiving no care from the VA for those over 65 years old (-0.8%, p = 0.012) and under 65 years old (-0.4%, p = 0.030).

Poorer economic conditions in a Veteran’s county of residence were associated with small, but statistically significant increases in the probability of using VA healthcare services.

The VA healthcare system has traditionally served as a safety net provider. Our findings suggest that the role of VA is magnified in locations and during time periods where unemployment is high. VA healthcare budgets should weigh the impact of business-cycle conditions in order to fully achieve the mandate of VA.

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