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BACKGROUND/RATIONALE:
Many veterans enrolled in VA healthcare also use private sector care, often more than the VA. Beyond specific medical needs, a veteran's reliance on VA versus non-VA care may depend on factors such as VA priority status, income, and insurance coverage, as well as proximity to needed services, which may be especially problematic for rural veterans. The dual use of medical systems raises several issues, such as continuity of care, the risks of redundant or conflicting treatments, and potential increased costs overall. Medicare coverage, which begins for most at age 65, is a primary factor in healthcare financing, and may increase veterans' use of private sector care. The proportion of VA enrollees who are younger than 65 is growing rapidly, yet we know very little about their reliance on VA versus private sector care. The VA obtains discharge data for all Medicare-funded private sector hospitalizations its enrollees undergo, but not other non-VA admissions. Sources of more comprehensive private sector utilization data, covering veterans of all ages, are very few, and the research literature is small. We propose to acquire administrative discharge data from several states, and national survey data, to fully represent the private sector hospitalizations for all VA enrollees, regardless of age or insurance coverage.
OBJECTIVE(S):
We will address three major research questions: 1) For which major diagnostic or medical service / procedure categories do VA enrollees obtain more inpatient care in the VA or in the private sector?; 2) Within each major diagnostic or service category, how much are insurance coverage, income, rural residence, proximity to care, and other individual characteristics associated with greater reliance on the private sector?; and 3) How well do free, readily obtainable national patient surveys represent the utilization, payers, and costs of veterans' private sector hospitalizations as well as the effects of patient characteristics on private sector reliance? A primary objective is to develop a comprehensive database spanning several recent years of a) discharge information for all VA enrollees living in several states, and b) national health survey data, including perceptions of access and costs, for enrollees' private sector hospitalizations, that will support multiple utilization and quality studies.
METHODS:
This is a retrospective, cross-sectional study comparing existing VA and private sector hospitalization data for VA enrollees. Data sources, spanning several recent years, will be of two types: a) administrative hospital discharge data for all VA and non-VA admissions obtained by VA enrollees living in nine states (including at least 1 million admissions), and b) hospital use and cost data from national surveys of healthcare consumers that include VA users (with several thousand admissions). Comparisons of utilization, health status, and payment information will be conducted for major diagnostic and service categories, accounting for the influences of age, VA priority status, Medicare or other insurance coverage, income, urban or rural residence, and distance to care. Analyses also will compare utilization estimates for major diagnostic and service categories derived from national health surveys to counts from administrative discharge data, to determine how well the inexpensively monitored surveys reflect the more costly discharge data.
FINDINGS/RESULTS:
The study is in start-up, and there are no findings to date.
IMPACT:
This study will yield information about how much VA enrollees rely on private sector inpatient care for different major diagnostic or service categories, and how this reliance changes with age, VA priority status, Medicare or other insurance coverage, income, urban or rural residence, and distance to care. This information will help VA managers to plan services that complement but do not duplicate those that enrollees can access in the private sector, and to reduce VA costs while optimizing veterans' use of care funded by other federal dollars. The study will assess how well free, readily available national patient surveys represent the utilization, payers, and costs of veterans' private sector admissions, which would permit inexpensive monitoring of trends in enrollees' use of VA and non-VA care in the future.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Health Services and Systems
DRE:
Quality of Care, Resource Use and Cost
Keywords:
Access, Cost, Utilization patterns
MeSH Terms:
none
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