Fee-for-Service Medicare-Enrolled Elderly Veterans Are Increasingly Voting with Their Feet to Use More VA and Less Medicare, 2003-2014
Fee-for-Service Medicare-Enrolled Elderly Veterans Are Increasingly Voting with Their Feet to Use More VA and Less Medicare, 2003-2014
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DOI：
10.1111/1475-6773.13029
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发表时间：
2018-12-01
影响因子：
3.4
通讯作者：
Hebert, Paul L.
中科院分区：
文献类型：
--
作者：
Liu, Chuan-Fen;Batten, Adam;Hebert, Paul L.
目的调查2003-2014年退伍军人事务部(简称退伍军人事务部)医疗系统和医保部按服务收费的老年退伍军人在人群(即系统)层面对门诊服务的长期依赖性。数据来源/研究背景我们使用退伍军人管理局的管理数据和医疗保险索赔，分析了5%的随机样本，按设施、年龄、性别和种族分层，这些退伍军人登记在退伍军人保险初级保健小组中。研究设计：我们对48个季度进行了重复的横断面分析。退伍军人管理局的依赖在系统层面上被定义为退伍军人管理局发生的总就诊(退伍军人管理局+医疗保险)的比例。我们检查了四种就诊类型和七个大容量的医学子专科。我们使用2010年参加联邦医疗保险的退伍军人的人口分布，对年龄、性别和种族进行了直接标准化调整。主要研究结果在12年期间，退伍军人管理局提供了绝大多数的精神卫生保健。相反，退伍军人通过医疗保险获得了略多于一半的初级护理和大部分专科护理、外科护理和七个大容量医疗子专科。然而，随着时间的推移，所有类别的护理对退伍军人管理局门诊护理的依赖程度稳步增加。结论尽管关于退伍军人管理局获得医疗服务的问题存在争议，但参加联邦医疗保险的退伍军人可以选择使用退伍军人管理局或医疗保险提供者，在《选择法案》之前，他们似乎增加了对退伍军人管理局医疗服务的使用。
Objective To examine the long-term reliance on outpatient care at the population (i.e., system) level among fee-for-service Medicare-enrolled elderly veterans in the Department of Veterans Affairs (VA) health care system and Medicare from 2003 to 2014. Data Sources/Study Setting We analyzed a 5 percent random sample, stratified by facility, age, gender, and race, of Medicare-enrolled veterans enrolled in a VA primary care panel using VA administrative data and Medicare claims. Study Design We performed a repeated cross-sectional analysis over 48 quarters. VA reliance was defined at the system level as the proportion of total visits (VA + Medicare) that occurred in VA. We examined four visit types and seven high-volume medical subspecialties. We applied direct standardization adjusting for age, gender, and race using the 2010 population distribution of Medicare-enrolled veterans. Principal Findings Over the 12-year period, VA provided the vast majority of mental health care. Conversely, veterans received slightly more than half of their primary care and most of their specialty care, surgical care, and seven high-volume medical subspecialties through Medicare. However, reliance on VA outpatient care steadily increased over time for all categories of care. Conclusions Despite the controversies about VA access to care, Medicare-enrolled veterans, who have a choice of using VA or Medicare providers, appear to increase their use of VA care prior to the Choice Act.