Veteran Use of Health Care Systems in Rural States: Comparing VA and Non-VA Health Care Use Among Privately Insured Veterans Under Age 65
Veteran Use of Health Care Systems in Rural States: Comparing VA and Non-VA Health Care Use Among Privately Insured Veterans Under Age 65
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DOI：
10.1111/jrh.12206
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发表时间：
2016-09-01
影响因子：
4.9
通讯作者：
West, Alan N.
中科院分区：
文献类型：
--
作者：
Charlton, Mary E.;Mengeling, Michelle A.;West, Alan N.
目的：量化使用VA和非VA护理工作年龄的退伍军人与私人保险的VA数据连接到私人健康保险计划（PHIP）data.Methods：人口统计学和利用率之间的VA和非VA系统的双用户与单系统用户的退伍军人< 65 living in 2 rural Midwestern states concurrently enrolled in VA health care and a PHIP for >= 1个完整的联邦财政年度从2000年至2010年进行了比较。单变量分析采用卡方检验和t检验。VA依赖性计算为VA的就诊、入院和处方的百分比。多项逻辑回归被用来比较特征的双重使用与非VA只或VA只use.Results：16,330合格的退伍军人，54%使用VA和非VA服务，39%使用非VA只，5%使用VA只。与单系统使用相比，双系统使用与年龄较大、优先级1-4、服务连接条件、农村居住、研究资格年限更长以及VA前入组PHIP相关。VA依赖于门诊治疗的比例为33%，住院治疗的比例为14%，药房的比例为40%。PHIP数据大大低估了VA使用相比，VA数据; 26%谁使用VA医疗保健没有VA索赔PHIP dataset.Conclusions：超过一半的工作年龄的退伍军人参加VA和私人保险使用的服务，在这两个系统。各系统的护理协调工作应包括所有年龄段的退伍军人，特别是农村退伍军人更有可能成为双重用户，需要更好的方法来确定有私人保险的退伍军人及其私人提供者。
Objective: To quantify use of VA and non-VA care among working-age veterans with private insurance by linking VA data to private health insurance plan (PHIP) data.Methods: Demographics and utilization were compared between dual users of VA and non-VA systems versus single-system users for veterans < 65 living in 2 rural Midwestern states concurrently enrolled in VA health care and a PHIP for >= 1 complete federal fiscal year from 2000 to 2010. Chi-square and t-tests were used for univariate analyses. VA reliance was computed as the percentage of visits, admissions and prescriptions in VA. Multinomial logistic regression was used to compare characteristics by dual use versus non-VA only or VA only use.Results: Of 16,330 eligible veterans, 54% used both VA and non-VA services, 39% used non-VA only, and 5% used VA only. Compared with single-system use, dual use was associated with older age, priority levels 1-4, service-connected conditions, rural residence, greater years of study eligibility, and enrollment in the PHIP before VA. VA reliance was 33% for outpatient care, 14% for inpatient, and 40% for pharmacy. PHIP data substantially underestimated VA use compared to VA data; 26% who used VA health care had no VA claims in the PHIP dataset.Conclusions: Over half of working-age veterans enrolled in VA and private insurance used services in both systems. Care coordination efforts across systems should include veterans of all ages, particularly rural veterans more likely to be dual users, and better methods are needed to identify veterans with private insurance and their private providers.