VA Health Economics Resource Center, VA Palo Alto, Menlo Park, California.
Stanford Surgery, Policy, Improvement, Research and Education Center, Palo Alto, California.
JAMA Netw Open. 2024 Aug 1;7(8):e2430205. doi: 10.1001/jamanetworkopen.2024.30205.
Department of Veterans Affairs (VA) health care spending has increased in the past decade, in part due to legislative changes that expanded access to VA-purchased care.
To understand how insurance coverage and enrollment in VA has changed between 2010 and 2021.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from surveys conducted from 2010 to 2021. Participants were respondents across 4 national surveys who reported being a US veteran and reported on health insurance enrollment. Data were analyzed from October 2023 to June 2024.
Self-reported health insurance coverage, reliance on VA insurance, and self-reported health.
Among a total of 3 644 614 survey respondents (mean [SE] age, 60 [0.04] years; 91.3% [95% CI, 91.2%-91.5%] male) included, 52.2% (95% CI, 52.0%-52.4%) were out of the labor market and 63.1% (95% CI, 62.9%-63.3%) were married. In 2010, 94% of all veterans and 94% of veterans younger than age 65 years reported having health insurance coverage on the American Community Survey. Insurance enrollment increased over time, and by 2020, 97% of all veterans and 95% of veterans younger than 65 years reported having health insurance coverage on the American Community Survey. Insurance enrollment estimates were similar across the surveys. Approximately one-third of veterans reported being enrolled in VA health coverage. Of those who enrolled in VA insurance, more than 75% had more than 1 form of coverage, with Medicare and private insurance being the most common second insurance sources. VA insurance enrollment was negatively associated with income and health status. Veterans without insurance tended to be unemployed and younger.
This study of veterans who responded to 4 national surveys found that veterans enrolled in VA health coverage had high rates of dual coverage. Further legislative efforts to increase access without recognizing the high rates of dual coverage may yield unintended consequences, such payer shifting.
在过去的十年中，美国退伍军人事务部（VA）的医疗保健支出有所增加，部分原因是立法改革扩大了退伍军人事务部购买的医疗服务的获取途径。
了解 2010 年至 2021 年间，VA 的保险覆盖范围和参保人数的变化情况。
设计、地点和参与者：这项横断面研究使用了 2010 年至 2021 年期间进行的调查数据。参与者是来自 4 项全国性调查的报告人，他们报告自己是美国退伍军人，并报告了健康保险的参保情况。数据分析于 2023 年 10 月至 2024 年 6 月进行。
自我报告的健康保险覆盖范围、对 VA 保险的依赖程度以及自我报告的健康状况。
在总共 3644614 名调查受访者中（平均[SE]年龄 60[0.04]岁；91.3%[95%CI，91.2%-91.5%]为男性），52.2%（95%CI，52.0%-52.4%）处于劳动力市场之外，63.1%（95%CI，62.9%-63.3%）已婚。2010 年，所有退伍军人中有 94%和年龄小于 65 岁的退伍军人中有 94%报告在美国社区调查中拥有健康保险覆盖范围。保险参保人数随时间增加，到 2020 年，所有退伍军人中有 97%和年龄小于 65 岁的退伍军人中有 95%报告在美国社区调查中拥有健康保险覆盖范围。调查中的保险参保人数估计值相似。大约三分之一的退伍军人报告参加了 VA 健康保险。在参加 VA 保险的退伍军人中，超过 75%的人有超过 1 种形式的保险，其中医疗保险和私人保险是最常见的第二份保险来源。VA 保险参保人数与收入和健康状况呈负相关。没有保险的退伍军人往往失业且年龄较小。
这项对回应了 4 项全国性调查的退伍军人进行的研究发现，参加 VA 健康保险的退伍军人有很高的双重保险覆盖率。进一步增加获取保险的立法努力，如果不认识到高双重保险覆盖率，可能会产生意想不到的后果，例如支付方转移。
