Wong Edwin S, Maciejewski Matthew L, Hebert Paul L, Batten Adam, Nelson Karin M, Fihn Stephan D, Liu Chuan-Fen
1 VA Puget Sound Health Care System, Seattle, WA, USA.
2 University of Washington, Seattle, WA, USA.
Med Care Res Rev. 2018 Feb;75(1):33-45. doi: 10.1177/1077558716669432. Epub 2016 Sep 20.
Massachusetts Health Reform (MHR), implemented in 2006, introduced new health insurance options that may have prompted some veterans already enrolled in the Veterans Affairs Healthcare System (VA) to reduce their reliance on VA health services. This study examined whether MHR was associated with changes in VA primary care (PC) use. Using VA administrative data, we identified 147,836 veterans residing in Massachusetts and neighboring New England (NE) states from October 2004 to September 2008. We applied difference-in-difference methods to compare pre-post changes in PC use among Massachusetts and other NE veterans. Among veterans not enrolled in Medicare, VA PC use was not significantly different following MHR for Massachusetts veterans relative to other NE veterans. Among VA-Medicare dual enrollees, MHR was associated with an increase of 24.5 PC visits per 1,000 veterans per quarter ( p = .048). Despite new non-VA health options through MHR, VA enrollees continued to rely on VA PC.
2006年实施的马萨诸塞州医疗改革（MHR）引入了新的医疗保险选项，这可能促使一些已加入退伍军人事务医疗系统（VA）的退伍军人减少对VA医疗服务的依赖。本研究调查了MHR是否与VA初级保健（PC）使用的变化有关。利用VA行政数据，我们确定了2004年10月至2008年9月期间居住在马萨诸塞州和邻近新英格兰（NE）州的147,836名退伍军人。我们应用差异-in-差异方法来比较马萨诸塞州和其他NE退伍军人在PC使用方面的前后变化。在未参加医疗保险的退伍军人中，相对于其他NE退伍军人，马萨诸塞州退伍军人在MHR之后的VA PC使用没有显著差异。在VA-医疗保险双重参保者中，MHR与每1000名退伍军人每季度增加24.5次PC就诊相关（p = 0.048）。尽管通过MHR有了新的非VA健康选项，但VA参保者继续依赖VA PC。
