U.S. Department of Veterans Affairs (VA), Office of Rural Health (ORH), Veterans Rural Health Resource Center in Salt Lake City, Salt Lake City, UT, United States of America.
Centers for American Indian and Alaska Native Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States of America.
PLoS One. 2022 Apr 1;17(4):e0266378. doi: 10.1371/journal.pone.0266378. eCollection 2022.
Many rural American Indian and Alaska Native (AIAN) veterans receive care from the Indian Health Service (IHS). United States Department of Veterans Affairs (VA) has reimbursement agreements with some IHS facilities and tribal programs and seeks to expand community partnerships in tribal areas, but details of how AIAN veterans use IHS are unknown. We aimed to assess the health status, service utilization patterns, and cost of care of veterans who use IHS.
We used comprehensive and integrated IHS data to compare health status, health service utilization and treatment cost of veterans (n = 12,242) to a matched sample of non-veterans (n = 12,242). We employed logistic, linear, or negative binomial regressions as appropriate, by sex and overall.
Compared to non-veterans, veterans had lower odds of having hypertension, renal disease, all-cause dementia, and alcohol or drug use disorders, but had similar burden of other conditions. In service utilization, veterans had lower hospital inpatient days; patterns were mixed across outpatient services. Unadjusted treatment costs for veterans and non-veterans were $3,923 and $4,145, respectively; veteran adjusted treatment costs were statistically lower. Differences in significance by sex were found for health conditions and service use.
AIAN veterans, compared to AIAN non-veterans, were not less healthy, nor did they require more intensive or more costly care under IHS. Our results indicate the viability and importance of expanding IHS-VA partnerships in community care.
许多美国印第安人和阿拉斯加原住民（AIAN）退伍军人接受印度卫生服务（IHS）的治疗。美国退伍军人事务部（VA）与一些 IHS 设施和部落项目签订了报销协议，并寻求在部落地区扩大社区伙伴关系，但 AIAN 退伍军人如何使用 IHS 的细节尚不清楚。我们旨在评估使用 IHS 的退伍军人的健康状况、服务利用模式和护理费用。
我们使用综合和综合的 IHS 数据，比较了退伍军人（n = 12242）和匹配的非退伍军人样本（n = 12242）的健康状况、卫生服务利用和治疗费用。我们根据性别和总体情况，分别采用逻辑、线性或负二项回归。
与非退伍军人相比，退伍军人患高血压、肾脏疾病、全因痴呆、酒精或药物使用障碍的可能性较低，但其他疾病的负担相似。在服务利用方面，退伍军人的住院天数较少；门诊服务的模式则各不相同。未经调整的退伍军人和非退伍军人的治疗费用分别为 3923 美元和 4145 美元；退伍军人的调整治疗费用在统计学上较低。在健康状况和服务使用方面，性别差异存在统计学意义。
与 AIAN 非退伍军人相比，AIAN 退伍军人的健康状况并不差，也不需要 IHS 提供更密集或更昂贵的护理。我们的研究结果表明，扩大 IHS-VA 社区护理伙伴关系具有可行性和重要性。
