Nelson Karin M, Starkebaum Gordon A, Reiber Gayle E
Primary and Specialty Medical Care Service, VA Puget Sound Health Care System, Seattle, WA 98107, USA.
Public Health Rep. 2007 Jan-Feb;122(1):93-100. doi: 10.1177/003335490712200113.
The objectives of this study were to: (1) examine veteran reliance on health services provided by the Veterans Health Administration (VA), (2) describe the characteristics of veterans who receive VA care, and (3) report rates of uninsurance among veterans and characteristics of uninsured veterans.
The authors analyzed data from the 2000 Behavioral Risk Factor Surveillance System. Using bivariate and multivariate analyses, the association of veteran's demographic characteristics, health insurance coverage, and use of VA services were examined. Veterans not reporting VA coverage and having no other source of health insurance were considered uninsured.
Among veteran respondents, 6.2% reported receiving all of their health care at the VA, 6.9% reported receiving some of their health care at the VA, and 86.9% did not use VA health care. Poor, less-educated, and minority veterans were more likely to receive all of their health care at the VA. Veterans younger than age 65 who utilized the VA for all of their health care also reported coverage with either private insurance (42.6%) or Medicare (36.3%). Of the veterans younger than age 65, 8.6% (population estimate: 1.3 million individuals) were uninsured. Uninsured veterans were less likely to be able to afford a doctor or see a doctor within the last year.
Veterans who utilized the VA for all of their health care were more likely to be from disadvantaged groups. A large number of veterans who could use VA services were uninsured. They should be targeted for VA enrollment given the detrimental clinical effects of being uninsured.
本研究的目的是:(1)调查退伍军人对退伍军人健康管理局(VA)提供的医疗服务的依赖程度;(2)描述接受VA医疗服务的退伍军人的特征;(3)报告退伍军人中的未参保率以及未参保退伍军人的特征。
作者分析了2000年行为风险因素监测系统的数据。运用双变量和多变量分析方法,研究退伍军人的人口统计学特征、医疗保险覆盖情况与VA服务使用之间的关联。未报告有VA保险覆盖且没有其他医疗保险来源的退伍军人被视为未参保。
在接受调查的退伍军人中,6.2%报告其所有医疗保健服务均在VA获得,6.9%报告部分医疗保健服务在VA获得,86.9%未使用VA医疗保健服务。贫困、受教育程度较低和少数族裔退伍军人更有可能在VA获得其所有医疗保健服务。65岁以下将VA作为其所有医疗保健服务提供者的退伍军人中,也有42.6%报告拥有私人保险,36.3%报告拥有医疗保险。在65岁以下的退伍军人中,8.6%(人口估计数:130万人)未参保。未参保退伍军人在过去一年中更没有能力负担看医生的费用或看医生。
将VA作为其所有医疗保健服务提供者的退伍军人更有可能来自弱势群体。大量有资格使用VA服务的退伍军人未参保。鉴于未参保对临床产生的不利影响,应对他们进行VA参保宣传。