Veteran Use of Health Care Systems in Rural States: Comparing VA and Non-VA Health Care Use Among Privately Insured Veterans Under Age 65

Mary E. Charlton, Michelle A. Mengeling, Jennifer A. Schlichting, Lan Jiang, Carolyn Turvey, Amal N. Trivedi, Kenneth W Kizer, Alan N. West

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)407-417
Number of pages11
JournalJournal of Rural Health
Volume32
Issue number4
DOIs
StatePublished - 2016

Keywords

  • care coordination
  • dual use
  • rural
  • VA health care
  • veterans

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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