Costs Associated with Health Care Services Accessed through VA and in the Community through Medicare for Veterans Experiencing Homelessness
Costs Associated with Health Care Services Accessed through VA and in the Community through Medicare for Veterans Experiencing Homelessness
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DOI：
10.1111/1475-6773.13054
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发表时间：
2018-12-01
影响因子：
3.4
通讯作者：
Gundlapalli, Adi V.
中科院分区：
文献类型：
--
作者：
Nelson, Richard E.;Suo, Ying;Gundlapalli, Adi V.
目的评估无家可归退伍军人相对于非无家可归退伍军人的医疗保健利用和费用，并研究退伍军人事务部无家可归计划对这些结果的影响。数据来源/研究设置退伍军人事务部（VA）行政和医疗保险索赔数据。研究设计观察性研究使用了退伍军人管理局系统和医疗保险登记的退伍军人的纵向数据。在2006年至2010年期间，有无家可归行政证据的退伍军人与没有无家可归证据的退伍军人在服兵役期间进行了匹配。无家可归的经历与退伍军人医院和非退伍军人医院每季度分别增加1.37 （95% CI = 1.34-1.40）和0.16 （95% CI = 0.14-0.17）门诊就诊次数有关，与退伍军人医院和非退伍军人医院每季度分别增加1.31 （95% CI = 1.30-1.32）和0.49 （95% CI = 0.48-0.49）住院天数有关。这些都与较高的成本有关。相对于65岁以下稳定居住的退伍军人，参加退伍军人事务部无家可归计划的退伍军人门诊就诊次数增加94.4% (95% CI = 90.7% - 98.1%)，但医疗保险门诊就诊次数减少5.5% （95% CI = 3.0% - 7.9%）。结论：无家可归与退伍军人事务部和医疗保险使用率和成本的增加有关。退伍军人事务部的无家可归者项目减少了医疗保险门诊服务的使用。
Objective To estimate health care utilization and costs incurred by homeless Veterans relative to nonhomeless Veterans and to examine the impact of a VA homelessness program on these outcomes. Data Sources/Study Setting Combined Department of Veterans Affairs (VA) administrative and Medicare claims data. Study Design Observational study using longitudinal data from Veterans engaged with the VA system and enrolled in Medicare. Veterans with administrative evidence of homelessness at any point during 2006-2010 were matched on period of military service to Veterans with no evidence of homelessness. Principal Findings Experience of homelessness was associated with 1.37 (95 percent CI = 1.34-1.40) and 0.16 (95 percent CI = 0.14-0.17) more outpatient encounters per quarter in VA and non-VA settings, respectively, and 1.31 (95 percent CI = 1.30-1.32) and 0.49 (95 percent CI = 0.48-0.49) more inpatient days per quarter in VA and non-VA hospitals, respectively. These were associated with higher costs. Relative to stably housed Veterans less than 65 years of age, those enrolled in a VA homelessness program had 94.4 percent (95 percent CI = 90.7 percent-98.1 percent) more VA outpatient visits but 5.5 percent (95 percent CI = 3.0 percent-7.9 percent) fewer Medicare outpatient visits. Conclusions Homelessness was associated with an increase in VA and Medicare utilization and cost. A VA homelessness program decreased use of Medicare outpatient services.