Local Area Unemployment and the Demand for Inpatient Care Among Veterans Affairs Enrollees.

Wong ES, Hebert PL, Nelson KM, Hernandez SE, Sylling PW, Fihn SD, Liu CF. Local Area Unemployment and the Demand for Inpatient Care Among Veterans Affairs Enrollees. Medical care research and review : MCRR. 2015 Aug 1; 72(4):468-80.

Related HSR&D Project(s)

• CDA 13-024 – Economic Impact of Dual Use and Patient Choice in Primary Care

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Abstract:

Prior research examining the relationship between economic conditions and health service demand has focused primarily on outpatient use. This study examines whether local area unemployment, as an indicator of economic conditions, was associated with use of inpatient care, which is theoretically less subject to discretionary use. Using a random sample of 131,603 patients dually enrolled in the Veterans Affairs (VA) Health System and fee-for-service Medicare, we measured VA, Medicare, and total (VA and Medicare) hospitalizations. Overall, local unemployment was not associated with VA, Medicare, or total hospitalization probability. Among low-income veterans exempt from VA copayments, higher local unemployment was moderately associated with a lower probability of hospitalization through Medicare. For veterans subject to VA copayments, higher local unemployment was moderately associated with a higher likelihood of VA hospitalization. These results suggest inpatient use is less sensitive to the economy, although worse economic conditions slightly affected inpatient demand for select veterans.