*Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System †Department of Health Services, University of Washington ‡Office of Analytics and Business Intelligence, Veterans Health Administration, Seattle, WA.
Med Care. 2014 Feb;52(2):137-43. doi: 10.1097/MLR.0000000000000079.
Prior research indicates that federal spending on Medicare, Medicaid, and other government health programs accelerated during the Great Recession.
To examine whether local unemployment was associated with utilization of Veterans Affairs Health Care System (VA) primary care, specialty care, and mental health services during 2004-2012.
We analyzed utilization of VA health services at the clinic level using fixed-effects negative binomial models. We stratified analyses by veterans' copayment status (exempt and nonexempt) and age (under 65 and 65+) to account for differences in VA utilization because of Medicare eligibility.
A total of 11,041,855 veterans assigned to 892 clinics identified in the VA Primary Care Management Module, representing nearly all veterans receiving primary care from VA, were included.
Clinic-level utilization was calculated quarterly as the total number of visits for patients assigned to a clinic. Local area unemployment rates were defined as quarterly unemployment rates within VA geographical planning sectors.
Higher local unemployment was associated with greater use of VA care in all categories among veterans exempt from copayments. The association between local unemployment and utilization differed by age group among veterans subject to copayments. Higher local unemployment was associated with lower use of primary and specialty care among Medicare-eligible veterans aged 65+, but greater use of primary care among veterans under age 65.
Our findings highlight the importance of the state of the economy in interpreting and forecasting demand for government health programs including VA, particularly during periods focused on deficit reduction.
先前的研究表明，在大衰退期间，联邦政府在医疗保险、医疗补助和其他政府卫生计划上的支出加速增长。
研究 2004 年至 2012 年间，当地失业率是否与退伍军人事务部医疗保健系统（VA）初级保健、专科保健和心理健康服务的利用有关。
我们使用固定效应负二项式模型在诊所层面分析 VA 卫生服务的利用情况。我们对符合条件和不符合条件的退伍军人的共付额状况以及年龄（65 岁以下和 65 岁以上）进行分层分析，以解释由于医疗保险资格而导致的 VA 利用差异。
共纳入 11041855 名被分配到 VA 初级保健管理模块中确定的 892 个诊所的退伍军人，这些退伍军人代表了从 VA 接受初级保健的几乎所有退伍军人。
诊所层面的利用情况按季度计算，为分配给诊所的患者的总就诊次数。当地地区失业率定义为 VA 地理规划部门内的季度失业率。
对于符合共付额条件的退伍军人，较高的当地失业率与所有类别的 VA 护理利用增加相关。在符合共付额条件的退伍军人中，当地失业率与利用之间的关联因年龄组而异。较高的当地失业率与 65 岁以上有医疗保险资格的退伍军人的初级和专科保健利用减少有关，但与 65 岁以下退伍军人的初级保健利用增加有关。
我们的研究结果强调了经济状况在解释和预测包括 VA 在内的政府卫生计划需求方面的重要性，尤其是在专注于减少赤字的时期。
