Veterans' access to and use of Medicare and veterans affairs health care
Veterans' access to and use of Medicare and veterans affairs health care
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DOI：
10.1097/01.mlr.0000244657.90074.b7
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发表时间：
2007-03-01
期刊：
影响因子：
3
通讯作者：
Kok, Linda
中科院分区：
文献类型：
--
作者：
Hynes, Denise M.;Koelling, Kristin;Kok, Linda
目标：我们研究了那些同时符合 Medicare 和退伍军人事务部 (VA) 服务资格的退伍军人中获得护理特征对医疗保健使用模式的影响。 方法：我们使用回顾性横断面设计来确定 1999 日历年有资格使用 VA 和 Medicare 医疗保健的退伍军人。我们分析了全国 VA 使用和 Medicare 索赔数据。我们使用描述性多变量广义有序 Logit 分析来研究患者、地理和环境因素如何影响对 VA 和 Medicare 住院和门诊服务的依赖百分比。结果：在我们研究人群中使用门诊服务的 147 万退伍军人中，18% 是仅 VA 用户，36% 是仅 Medicare 用户，46% 是 VA 和 Medicare 用户。在住院使用的退伍军人中，24% 仅使用 VA，69% 仅使用 Medicare，6% 同时使用 VA 和 Medicare。多变量分析显示，黑人或优先考虑退伍军人事务部的退伍军人最有可能依赖退伍军人事务部。风险评分较高的患者最有可能依赖 VA 和 Medicare 医疗保健的组合。住得离退伍军人管理局医院较远的患者不太可能依赖退伍军人管理局的医疗保健，特别是住院护理。生活在拥有更多医疗资源的城市地区的患者不太可能依赖 VA 医疗保健。结论：VA 医疗保健为弱势群体提供了重要的安全网。仔细考虑退伍军人事务部和医疗保险政策变化对少数族裔和高风险人群的同时影响的有针对性的方法对于确保退伍军人获得所需的医疗保健至关重要。
Objectives: We examined the impact of access to care characteristics on health care use patterns among those veterans dually eligible for Medicare and Veterans Affairs (VA) services,.Methods: We used a retrospective, cross-sectional design to identify veterans who were eligible to use VA and Medicare health care in calendar year 1999. We analyzed national VA utilization and Medicare claims data. We used descriptive and multivariable generalized ordered logit analyses to examine how patient, geographic, and environmental factors affect the percent reliance on VA and Medicare inpatient and outpatient services.Results: Of the 1.47 million veterans in our study population with outpatient use, 18% were VA-only users, 36% were Medicare-only users, and 46% were both VA and Medicare users. Among veterans with inpatient use, 24% were VA only, 69% were Medicare only, and 6% were both VA and Medicare users. Mulfivariable analysis revealed that veterans who were black or had a higher VA priority were most likely to rely on the VA. Patient with higher risk scores were most likely to rely on a combination of VA and Medicare health care. Patients who lived farther from VA hospitals were less likely to rely on VA health care, particularly for inpatient care. Patients living in urban areas with more health caxe resources were less likely to rely on VA health care.Conclusions: VA health care provides an important safety net for vulnerable populations. Targeted approaches that carefully consider the simultaneous impacts of VA and Medicare policy changes on minority and high-risk populations are essential to ensure veterans have access to needed health care.