Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA.
BMC Health Serv Res. 2012 Mar 5;12:51. doi: 10.1186/1472-6963-12-51.
More than half of veterans who use Veterans Health Administration (VA) care are also eligible for Medicare via disability or age, but no prior studies have examined variation in use of outpatient services by Medicare-eligible veterans across health system, type of care or time.
To examine differences in use of VA and Medicare outpatient services by disability-eligible or age-eligible veterans among veterans who used VA primary care services and were also eligible for Medicare.
A retrospective cohort study of 4,704 disability- and 10,816 age-eligible veterans who used VA primary care services in fiscal year (FY) 2000. We tracked their outpatient utilization from FY2001 to FY2004 using VA administrative and Medicare claims data. We examined utilization differences for primary care, specialty care, and mental health outpatient visits using generalized estimating equations.
Among Medicare-eligible veterans who used VA primary care, disability-eligible veterans had more VA primary care visits (p < 0.001) and more VA specialty care visits (p < 0.001) than age-eligible veterans. They were more likely to have mental health visits in VA (p < 0.01) and Medicare-reimbursed visits (p < 0.01). Disability-eligible veterans also had more total (VA+Medicare) visits for primary care (p < 0.01) and specialty care (p < 0.01), controlling for patient characteristics.
Greater use of primary care and specialty care visits by disability-eligible veterans is most likely related to greater health needs not captured by the patient characteristics we employed and eligibility for VA care at no cost. Outpatient care patterns of disability-eligible veterans may foreshadow care patterns of veterans returning from Afghanistan and Iraq wars, who are entering the system in growing numbers. This study provides an important baseline for future research assessing utilizations among returning veterans who use both VA and Medicare systems. Establishing effective care coordination protocols between VA and Medicare providers can help ensure efficient use of taxpayer resources and high quality care for disabled veterans.
超过一半使用退伍军人健康管理局（VA）医疗服务的退伍军人，也因残疾或年龄而有资格获得医疗保险，但之前没有研究调查过在整个医疗体系、护理类型或时间范围内，符合医疗保险条件的退伍军人对门诊服务的使用情况存在差异。
检查在使用 VA 初级保健服务且也有资格获得医疗保险的退伍军人中，因残疾而有资格或因年龄而有资格的退伍军人对 VA 和 Medicare 门诊服务的使用差异。
这是一项对 2000 财年使用 VA 初级保健服务的 4704 名残疾和 10816 名年龄合格的退伍军人的回顾性队列研究。我们使用 VA 管理和医疗保险索赔数据，从 2001 财年到 2004 财年追踪他们的门诊利用情况。我们使用广义估计方程检查初级保健、专科保健和心理健康门诊就诊的利用差异。
在使用 VA 初级保健的医疗保险合格退伍军人中，残疾合格退伍军人的 VA 初级保健就诊次数更多（p < 0.001），VA 专科保健就诊次数也更多（p < 0.001）。他们更有可能在 VA（p < 0.01）和医疗保险报销的就诊中（p < 0.01）进行心理健康就诊。残疾合格退伍军人在 VA+医疗保险的初级保健（p < 0.01）和专科保健（p < 0.01）就诊总数也更多，这是在控制患者特征的情况下。
残疾合格退伍军人更多地使用初级保健和专科保健就诊，最有可能是由于我们所采用的患者特征未捕捉到的更大的健康需求以及无成本获得 VA 护理的资格。残疾合格退伍军人的门诊就诊模式可能预示着从阿富汗和伊拉克战争返回的退伍军人的就诊模式，他们越来越多地进入该系统。这项研究为未来评估同时使用 VA 和医疗保险系统的退伍军人利用情况的研究提供了重要的基线。在 VA 和医疗保险提供者之间建立有效的护理协调协议，可以帮助确保纳税人资源的有效利用和为残疾退伍军人提供高质量的护理。
