Durham VA Health Care System, Durham, NC, USA.
Duke University, Durham, NC, USA.
Med Care Res Rev. 2022 Apr;79(2):218-232. doi: 10.1177/10775587211018548. Epub 2021 May 31.
Support policies for caregivers improves care-recipient access to care and effects may generalize to nonhealth services. Using administrative data from the U.S. Department of Veterans Affairs (VA) for veterans <55 years, we assessed the association between enrollment in a VA caregiver support program and veteran use of vocational assistance services: the post-9/11 GI Bill, VA vocational rehabilitation and employment (VR&E), and supported employment. We applied instrumental variables to Cox proportional hazards models. Caregiver enrollment in the program increased veteran supported employment use (hazard ratio = 1.35, 95% confidence interval [1.14, 1.53]), decreased VR&E use (hazard ratio = 0.84, 95% confidence interval [0.76, 0.92]), and had no effect on the post-9/11 GI Bill. Caregiver support policies could increase access to some vocational assistance for individuals with disabilities, particularly supported employment, which is integrated into health care. Limited coordination between health and employment sectors and misaligned incentives may have inhibited effects for the post-9/11 GI Bill and VR&E.
为照料者提供支持政策可以改善照料对象获得照料的机会，其效果可能会推广到非卫生服务领域。我们使用美国退伍军人事务部（VA）的行政数据，对年龄在 55 岁以下的退伍军人进行了研究，评估了参加 VA 照料者支持计划与退伍军人使用职业援助服务之间的关联：9/11 后 GI 法案、VA 职业康复和就业（VR&E）以及支持性就业。我们应用工具变量法对 Cox 比例风险模型进行了分析。参加该计划的照料者人数增加了退伍军人接受支持性就业的比例（风险比=1.35，95%置信区间[1.14, 1.53]），减少了 VR&E 的使用（风险比=0.84，95%置信区间[0.76, 0.92]），对 9/11 后 GI 法案没有影响。照料者支持政策可以增加残疾人获得某些职业援助的机会，特别是与医疗保健相结合的支持性就业。卫生和就业部门之间的协调有限以及激励措施的不匹配可能会抑制 9/11 后 GI 法案和 VR&E 的效果。
