VA Health Services Research & Development (HSR&D) Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon; Department of Health Systems Management & Policy, Oregon Health & Science University - Portland State University School of Public Health, Portland, Oregon.
VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.
Am J Prev Med. 2023 Sep;65(3):406-416. doi: 10.1016/j.amepre.2023.03.004. Epub 2023 Mar 9.
The Veterans Health Administration (VA) provides low- to no-cost care to enrolled veterans with low incomes. This study assessed the associations between VA coverage and medical financial hardship among U.S. veterans with low incomes.
Using 2015-2018 National Health Interview Survey data, veterans aged ≥18 years with incomes <200% of the Federal Poverty Level were identified (crude n=2,468, weighted n=3,872,252). Four types of medical financial hardship were assessed: objective, and subjective material, psychologic, and behavioral medical financial hardship. Survey-weighted proportions of veterans with medical financial hardship were calculated, and adjusted probabilities of medical financial hardship that accounted for Veteran characteristics, year-fixed effects, and survey sampling design were estimated. Analyses were conducted from August through December 2022.
Overall, 34.5% of veterans with low incomes had VA coverage. Among veterans without VA coverage, 38.7% had Medicare insurance, 18.2% had Medicaid insurance, 16.5% had private insurance, 13.5% had other public insurance, and 13.1% were uninsured. In adjusted analyses, veterans with VA coverage had lower probabilities of objective (-8.13 percentage point, p=0.008), subjective material (-6.55 percentage point, p=0.034), subjective psychologic (-10.33 percentage point, p=0.003), and subjective behavioral (-6.72 percentage point, p=0.031) medical financial hardship than veterans with Medicare and no VA coverage.
VA coverage was associated with protection against four types of medical financial hardship among veterans with low incomes, yet many are not enrolled. Research is needed to understand reasons these veterans lack VA coverage and to identify strategies to address medical financial hardship.
退伍军人事务部 (VA) 为收入较低的在册退伍军人提供低成本或免费的医疗服务。本研究评估了 VA 覆盖范围与美国低收入退伍军人医疗财务困难之间的关联。
使用 2015-2018 年全国健康访谈调查数据，确定了收入低于联邦贫困水平 200%的年龄≥18 岁的退伍军人（未加权 n=2,468，加权 n=3,872,252）。评估了四种类型的医疗财务困难：客观、主观物质、心理和行为医疗财务困难。计算了有医疗财务困难的退伍军人的调查加权比例，并根据退伍军人特征、年度固定效应和调查抽样设计估计了有医疗财务困难的调整概率。分析于 2022 年 8 月至 12 月进行。
总体而言，34.5%的低收入退伍军人有 VA 覆盖。在没有 VA 覆盖的退伍军人中，38.7%有医疗保险，18.2%有医疗补助保险，16.5%有私人保险，13.5%有其他公共保险，13.1%没有保险。在调整后的分析中，与没有医疗保险和 VA 覆盖的退伍军人相比，有 VA 覆盖的退伍军人客观（-8.13 个百分点，p=0.008）、主观物质（-6.55 个百分点，p=0.034）、主观心理（-10.33 个百分点，p=0.003）和主观行为（-6.72 个百分点，p=0.031）的医疗财务困难的可能性较低。
VA 覆盖与低收入退伍军人的四种类型的医疗财务困难的保护有关，但仍有许多退伍军人没有注册。需要研究了解这些退伍军人缺乏 VA 覆盖的原因，并确定解决医疗财务困难的策略。
