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Harada N, Washington D, Makinodan T, Liu H, Dhanani S. Does military status influence use of VA ambulatory care? Paper presented at: VA HSR&D National Meeting; 1999 Feb 24; Washington, DC.
Objectives: Military experiences have been documented to influence a veteran's subsequent use of health care services. Specifically, these military experiences may serve as predisposing, enabling, or need variables affecting VA ambulatory care utilization. The objectives of this study were to identify military status factors predictive of VA ambulatory care use, and to determine whether these factors remain significant after controlling for race/ethnicity, sociodemographic, and health status characteristics. Methods: The source of data was the 1992 National Survey of Veterans (NSV). Since the NSV sample is 97% male, our analyses were limited to this gender group. Bivariate analyses were conducted to describe the demographic and military status characteristics of VA ambulatory care users and non-users. A hierarchical logistic regression analysis was conducted with use of VA ambulatory care as the dependent variable. The initial logistic model included several variables descriptive of military status, followed by 3 additional models controlling for race/ethnicity, sociodemographic, and health status. Results: Of the total sample (n = 7,851, mean age = 56 years), 41% had used VA ambulatory care services in the previous year. Sixty-four percent of the VA users came exclusively to the VA for ambulatory care, and the remaining had used the VA in conjunction with non-VA ambulatory care. The first model explored the contribution of military status variables to ambulatory care use without controlling for race/ethnicity, sociodemographic, or health status. Significant military status variables included retirement from the military for disability (OR = 1.6), combat exposure (OR = 1.1), service in the Marines (OR = 1.3), Army (OR = 1.3), or during the Korean Conflict (OR = 1.3), service-connected injury (OR = 1.6), 6 or more years of military service (OR = 1.3), and retirement from the military after 20 years of service (OR = .58). Controlling for race/ethnicity in the second model did not alter the list of significant military status variables. The inclusion of sociodemographic characteristics in model 3 decreased the list of significant military status variables to service in the Marines (OR = 1.6), service-connected injury (OR = 1.2), and 6 or more years of service (OR = 1.4). After controlling for race/ethnicity, sociodemographic, and health status in the final model only military service for 6 or more years remained significant (OR = 1.4). However the final model showed that veterans who are minorities, of lower socioeconomic status, uninsured, have poor health status and a service-connected disability have a greater likelihood of being a VA ambulatory care user.Conclusions: The findings demonstrate that the VA serves as an important source of health care for veterans with service-connected disabilities and long term service in the military. In addition, veterans who are minorities, of low socioeconomic status and poor health status also use the VA for ambulatory care. Impact: Military status characteristics describing veterans who use ambulatory care highlight the importance of health care entitlement for Americans who served their country. The VA serves as an important source of ambulatory care for veterans with service-connected disabilities and long term service in the military. As the VA seeks to restructure its delivery of ambulatory care, it must create policies to benefit this deserving population.