Charlton Mary E, Mengeling Michelle A, Schlichting Jennifer A, Jiang Lan, Turvey Carolyn, Trivedi Amal N, Kizer Kenneth W, West Alan N
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.
VA Office of Rural Health, Rural Health Resource Center-Central Region, and the Comprehensive Access and Delivery Research and Evaluation (CADRE), Center at the Iowa City VA Healthcare System, Iowa City, Iowa.
J Rural Health. 2016 Sep;32(4):407-417. doi: 10.1111/jrh.12206. Epub 2016 Aug 25.
To quantify use of VA and non-VA care among working-age veterans with private insurance by linking VA data to private health insurance plan (PHIP) data.
Demographics and utilization were compared between dual users of VA and non-VA systems versus single-system users for veterans < 65 living in 2 rural Midwestern states concurrently enrolled in VA health care and a PHIP for ≥ 1 complete federal fiscal year from 2000 to 2010. Chi-square and t-tests were used for univariate analyses. VA reliance was computed as the percentage of visits, admissions and prescriptions in VA. Multinomial logistic regression was used to compare characteristics by dual use versus non-VA only or VA only use.
Of 16,330 eligible veterans, 54% used both VA and non-VA services, 39% used non-VA only, and 5% used VA only. Compared with single-system use, dual use was associated with older age, priority levels 1-4, service-connected conditions, rural residence, greater years of study eligibility, and enrollment in the PHIP before VA. VA reliance was 33% for outpatient care, 14% for inpatient, and 40% for pharmacy. PHIP data substantially underestimated VA use compared to VA data; 26% who used VA health care had no VA claims in the PHIP dataset.
Over half of working-age veterans enrolled in VA and private insurance used services in both systems. Care coordination efforts across systems should include veterans of all ages, particularly rural veterans more likely to be dual users, and better methods are needed to identify veterans with private insurance and their private providers.
通过将退伍军人事务部（VA）数据与私人医疗保险计划（PHIP）数据相链接，量化有私人保险的工作年龄退伍军人对VA和非VA医疗服务的使用情况。
对居住在中西部两个农村州、年龄小于65岁、在2000年至2010年期间同时参加VA医疗保健和PHIP且参保时间不少于1个完整联邦财政年度的退伍军人进行比较，分析VA和非VA系统的双重使用者与单一系统使用者之间的人口统计学特征和医疗服务利用情况。采用卡方检验和t检验进行单因素分析。VA依赖度通过VA就诊、住院和处方的百分比来计算。使用多项逻辑回归比较双重使用与仅使用非VA或仅使用VA的特征。
在16330名符合条件的退伍军人中，54%同时使用了VA和非VA服务，39%仅使用非VA服务，5%仅使用VA服务。与单一系统使用相比，双重使用与年龄较大、1-4级优先等级、与服役相关的疾病、农村居住、更长的符合参保条件年限以及在加入VA之前就已加入PHIP有关。门诊医疗的VA依赖度为33%，住院为14%，药房为40%。与VA数据相比，PHIP数据大幅低估了VA的使用情况；在PHIP数据集中，26%使用VA医疗服务的退伍军人没有VA索赔记录。
参加VA和私人保险的工作年龄退伍军人中，超过一半的人在两个系统中都使用了服务。跨系统的医疗协调工作应涵盖所有年龄段的退伍军人，尤其是更有可能成为双重使用者的农村退伍军人，并且需要更好的方法来识别有私人保险的退伍军人及其私人医疗服务提供者。
