Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.
Loyola University Chicago, Maywood, IL, USA.
Med Care Res Rev. 2022 Aug;79(4):511-524. doi: 10.1177/10775587211048661. Epub 2021 Oct 8.
Reasons for acquiring insurance outside Department of Veterans Affairs (VA) health care coverage among VA enrollees are incompletely understood. To assess Veterans' decision-making and acquisition of non-VA health care insurance in the Affordable Care Act era, we used mailed questionnaires and semistructured interviews in a stratified random sample of VA enrollees <65 years in the Midwest. Of the 3,666 survey participants, 32.1% reported non-VA insurance. Frequently reported reasons included wanting coverage for emergency situations or family members. Those without non-VA insurance cited unaffordability as the main obstacle. Analysis of the semistructured interview data revealed similar findings. In multivariable logistic regression analyses, characteristics associated with non-VA insurance included higher income (>$50,000 vs. <$10,000, odds ratio [OR] = 5.95, 95% confidence interval [CI]: 3.45-10.3, < .001). As financial barriers exist for acquisition of non-VA insurance and hence community care, it is critically important that VA enrollees' health care needs are met through VA or community providers financed through VA.
退伍军人事务部（VA）医疗保健覆盖范围之外的参保原因尚不完全清楚。为了评估退伍军人在平价医疗法案时代做出的决策和获取非 VA 医疗保险的情况，我们在中西部地区使用邮寄问卷和半结构化访谈，对 65 岁以下的 VA 参保者进行了分层随机抽样。在 3666 名调查参与者中，32.1%的人报告说拥有非 VA 保险。经常提到的原因包括想要覆盖紧急情况或家庭成员。那些没有非 VA 保险的人则表示主要障碍是负担不起。对半结构化访谈数据的分析显示了类似的发现。在多变量逻辑回归分析中，与非 VA 保险相关的特征包括更高的收入（>$50,000 与<$10,000，优势比 [OR] = 5.95，95%置信区间 [CI]：3.45-10.3，<.001）。由于获取非 VA 保险和社区医疗存在经济障碍，因此通过 VA 或社区提供者来满足 VA 参保者的医疗需求至关重要，这些提供者的资金来源于 VA。
