Gender disparities in Veterans Health Administration care: importance of accounting for veteran status.

BACKGROUND

In an effort to assess and reduce gender-related quality gaps, the Veterans Health Administration (VHA) has promoted gender-based research. Historically, such appraisals have often relied on secondary databases, with little attention to methodological implications of the fact that VHA provides care to some nonveteran patients.

OBJECTIVES

To determine whether conclusions about gender differences in utilization and cost of VHA care change after accounting for veteran status.

DESIGN

Cross-sectional.

SUBJECTS

All users of VHA in 2002 (N = 4,429,414).

MEASURES

Veteran status, outpatient/inpatient utilization and cost, from centralized 2002 administrative files.

RESULTS

Nonveterans accounted for 50.7% of women (the majority employees) but only 3.0% of men. Among all users, outpatient and inpatient utilization and cost were far lower in women than in men, but in the veteran subgroup these differences decreased substantially or, in the case of use and cost of outpatient care, reversed. Utilization and cost were very low among women employees; women spouses of fully disabled veterans had utilization and costs similar to those of women veterans.

CONCLUSIONS

By gender, nonveterans represent a higher proportion of women than of men in VHA, and some large nonveteran groups have low utilization and costs; therefore, conclusions about gender disparities change substantially when veteran status is taken into account. Researchers seeking to characterize gender disparities in VHA care should address this methodological issue, to minimize risk of underestimating health care needs of women veterans and other women eligible for primary care services.