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Health care trends for Medicare beneficiaries by veteran status: 1992-2002

Jonk Y, Cutting A, O'Connor H, Dowd B, Cowper D, Klingner J, Feldman R. Health care trends for Medicare beneficiaries by veteran status: 1992-2002. Poster session presented at: AcademyHealth Annual Research Meeting; 2006 Jun 26; Seattle, WA.


Objective: Analyze trends in the demographic characteristics, health status, health insurance, and utilization of Veterans Health Administration (VHA's) health care services for veteran Medicare beneficiaries five years before and after VHA 1996 administrative and eligibility reforms. Methods:. An observational study utilizing longitudinal cohort survey data. The Medicare Current Beneficiary Survey identifies veterans and serves as the primary data source. VHA administrative changes taking place in the mid-1990s are believed to equally influence the utilization and cost of services for the experimental and control groups, while these groups differ in their response to the 1996 expansions in eligibility. The control group consists of service connected (SC) and low-income veterans, and the experimental group are non-service connected veterans whose incomes fall above the means test thresholds (NSCMT). Findings: Over the past decade, veterans consistently comprised over a quarter of Medicare beneficiaries. While the vast majority of veterans were white males over the age of 65, veterans in the control group were a more racially diverse group. They were more likely to be black and report Hispanic ethnicity than the NSCMT group. Although both groups tended to become better educated over time, veterans in the control group were less educated, less likely to be married, more likely to be divorced or widowed, and had lower household incomes. While approximately one-fourth of veterans in the control group were SC, the percentage with SC ratings between 1-25% has been decreasing, while those greater than 75% has been increasing. While the percentage of veterans enrolled in Medicare HMOs has been increasing, the rate of increase has been higher for the control than the NSCMT groups. The percentage of veterans in the control group dually enrolled in Medicaid is higher than the NSCMT and has been increasing at a faster rate. NSCMT veterans are more likely to carry supplemental insurance, be in excellent to very good health, and report no problems with Activities of Daily Living (ADLs) and Independent ADLs than the control group. While a higher percentage of the control group report having chronic conditions, some of these differences are mitigated by the influx of NSCMT veterans having these conditions post 1996. Although use of VHA services was more prevalent within the control group both pre and post 1996, usage rates for outpatient and prescription drug services increased significantly across both groups. No clear patterns in terms of the percent of VA users within either group who report poor health status, chronic conditions, or trouble with ADLs/IADLs exist pre and post 1996. Conclusions: VHA administrative and eligibility reforms have increased reliance on the VHA. While veterans in the control group are of lower socioeconomic and health status than the NSCMT group, no clear evidence of adverse selection among newly eligible NSCMT veterans using the VHA exists.

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