Long Judith A, Polsky Daniel, Metlay Joshua P
Philadelphia Veterans Affairs Center for Health Equity Research and Promotion, University of Pennsylvania's Leonard Davis Institute of Health Economics, PA 19104-6021, USA.
Am J Public Health. 2005 Dec;95(12):2246-51. doi: 10.2105/AJPH.2004.061127. Epub 2005 Oct 27.
During the mid-1990s, the Veterans Health Administration (VHA) reorganized and placed greater emphasis on high-quality primary care. To determine whether the reorganization was associated with changes in patterns of out-patient VHA use, we sought to evaluate changes in characteristics of veterans who use VHA outpatient services between 1992 and 2000.
We merged 2 waves of the National Survey of Veterans to determine changes in patterns of outpatient care use. We evaluated the extent to which veterans who received outpatient care received that care from the VHA.
The odds ratio for VHA-only outpatient care relative to non-VHA-only care in 2000 relative to 1992 was 1.75 (95% confidence interval [CI]=1.51, 2.04), and the odds ratio for dual relative to non-VHA-only care was 1.22 (95% CI=1.08, 1.37). Veterans who were older, had low incomes, and had no additional health insurance coverage were most likely to increase their use of VHA outpatient care.
Our results suggest that the VHA is increasingly serving veterans who have trouble accessing the private health care system.
在20世纪90年代中期，退伍军人健康管理局（VHA）进行了重组，并更加重视高质量的初级保健。为了确定这种重组是否与VHA门诊使用模式的变化有关，我们试图评估1992年至2000年间使用VHA门诊服务的退伍军人特征的变化。
我们合并了两波全国退伍军人调查，以确定门诊护理使用模式的变化。我们评估了接受门诊护理的退伍军人从VHA获得该护理的程度。
与1992年相比，2000年仅使用VHA门诊护理相对于非仅使用VHA门诊护理的优势比为1.75（95%置信区间[CI]=1.51，2.04），而双重使用相对于非仅使用VHA门诊护理的优势比为1.22（95%CI=1.08，1.37）。年龄较大、收入较低且没有额外医疗保险的退伍军人最有可能增加对VHA门诊护理的使用。
我们的结果表明，VHA越来越多地为难以进入私人医疗保健系统的退伍军人提供服务。
