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Providing Free Care for Veterans with Military Sexual Trauma Does Not Result in Major Income Loss to VA


Since 2002 there have been no co-payments for VA healthcare related to military sexual trauma (MST), defined by VA as sexual assault or harassment that took place during military service. Congress eliminated the co-payment for care related to MST in order to reduce the financial barrier to treatment; however, eliminating co-payments reduces income for the VA healthcare system. The potential loss may be substantial because more than 70,000 Veterans who use VA healthcare had screened positive for MST by FY2006. This retrospective study estimated the loss in outpatient co-payment revenue for VA due to the mandate for free care related to MST. Investigators analyzed VA data for all Veterans who received VA healthcare and screened positive for MST from FY06 through FY08. The number of Veterans with outpatient encounters related to MST rose from approximately 44,000 in FY06 to 57,000 in FY08. Women had the majority of these encounters.

Findings show that about 95% of Veterans who received outpatient care for military sexual trauma would have had no co-payment, even in the absence of a free-care mandate. The estimated co-payment revenue foregone by the free-care mandate for MST was modest, totaling about $418,000 in FY06, $517,000 in FY07, and $455,000 in FY08. These totals represented only .04-.05% of first-party co-payment revenues for outpatient care. These results suggest that VA can continue to provide free care for patients who have experienced military sexual trauma without major income loss.

PubMed Logo Smith M, Chow A, and Kimerling R. Estimating lost revenue from a free-care mandate in VA. Psychiatric Services November 2010;61(11):1150-1152.

This study was funded by HSR&D (IAE 05-291). Drs. Smith and Kimerling are part of HSR&D’s Health Economics Resource Center (HERC) in Palo Alto, CA.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.