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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

1053 — Changes in VA Service Utilization Patterns as VA Patients Age and Become Medicare Eligible

Vaughan Sarrazin MS, and Rosenthal GE, Iowa City VAMC;

Understanding how access to private sector health care impacts VA utilization is critical to estimating the impact of US healthcare reform on future VA service use. This study tracks service use over time as Veterans become eligible for Medicare, in order to demonstrate how the demand for specific services may change as the result of increased access to private sector care.

Veterans in VISN 23 who were 62 years of age in FY2002 and who were enrolled in VA during FY2002 through FY2010 were identified (n = 88,551). The numbers of specific outpatient and inpatient services and prescription drugs used during each year were calculated for each patient using information in VA administrative and pharmacy files. Outpatient encounters were categorized as Primary Care, Specialty, Mental Health, Rehabilitative, or Diagnostic Radiology. Inpatient admissions were categorized as medical or surgical. Pharmaceuticals were collapsed into 23 drug categories. Analyses evaluated trends in utilization for the entire sample and for groups classified by means testing.

Utilization increased (p <.001) for most services as patients aged – with increases of 31% for primary care visits (mean of 3.1 in 2002 to 4.1 in 2010), 97% for mental health (mean of 0.6 to 1.3), 14% for diagnostic radiology encounters (mean of 0.9 to 1.1), and 20% for the number of drug prescription categories obtained (mean of 4.5 to 5.4). In contrast, the mean number of specialty physician visits decreased by 6% (2.1 to 2.0), surgical admissions decreased by 17% (2.4 to 2.0 admissions per 100 patients), and rehabilitative service encounters decreased by 10% (mean of 0.9 to 0.8). These decreases were greatest among patients with service connected disabilities or low income.

Despite increasing eligibility for services through Medicare as Veterans reach age 65, the use of most VA services increased as patients aged through their 60’s. However, the use of VA services related to specialty, surgical, and rehabilitative services decreased, even though the need for such services likely increases as Veterans age, suggesting a shift in the receipt of these services to the private sector.

The impact of healthcare reform on VA service utilization will likely vary by type of service.

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