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Gender Disparities in Veterans Health Administration Care: Importance of Accounting for Veteran Status

Frayne, Susan M. MD, MPH*†‡§; Yano, Elizabeth M. PhD¶∥; Nguyen, Vu Q. BS*; Yu, Wei PhD*‡**§§; Ananth, Lakshmi MS**; Chiu, Victor Y. BA*; Phibbs, Ciaran S. PhD*‡**††‡‡

doi: 10.1097/MLR.0b013e3181608115
Brief Report

Background: In an effort to assess and reduce gender-related quality gaps, the Veterans Health Administration (VHA) has promoted gender-based research. Historically, such appraisals have often relied on secondary databases, with little attention to methodological implications of the fact that VHA provides care to some nonveteran patients.

Objectives: To determine whether conclusions about gender differences in utilization and cost of VHA care change after accounting for veteran status.

Design: Cross-sectional.

Subjects: All users of VHA in 2002 (N = 4,429,414).

Measures: Veteran status, outpatient/inpatient utilization and cost, from centralized 2002 administrative files.

Results: Nonveterans accounted for 50.7% of women (the majority employees) but only 3.0% of men. Among all users, outpatient and inpatient utilization and cost were far lower in women than in men, but in the veteran subgroup these differences decreased substantially or, in the case of use and cost of outpatient care, reversed. Utilization and cost were very low among women employees; women spouses of fully disabled veterans had utilization and costs similar to those of women veterans.

Conclusions: By gender, nonveterans represent a higher proportion of women than of men in VHA, and some large nonveteran groups have low utilization and costs; therefore, conclusions about gender disparities change substantially when veteran status is taken into account. Researchers seeking to characterize gender disparities in VHA care should address this methodological issue, to minimize risk of underestimating health care needs of women veterans and other women eligible for primary care services.

From the *Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, California; †Division of General Internal Medicine, Stanford University School of Medicine, Palo Alto, California; ‡Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, California; §Women's Health Center, VA Palo Alto Health Care System, Palo Alto, California; ¶VA Greater Los Angeles HSR&D Center for the Study of Healthcare Provider Behavior, Sepulveda, California; ∥Department of Health Services, UCLA School of Public Health, Los Angeles, California; **Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, California; ††Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, California; ‡‡Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; and §§Shanghai University of Finance and Economics, Shanghai, China.

Supported by Department of Veterans Affairs Health Services Research and Development grants RCD 98-312 and SDR-ECN-99017 and by Department of Veterans Affairs’ Office of Research and Development Project CSF 04-376.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Reprints: Susan Frayne, MD, MPH, Center for Health Care Evaluation, 795 Willow Road (152-MPD), Menlo Park CA 94025. E-mail: sfrayne@stanford.edu.

© 2008 Lippincott Williams & Wilkins, Inc.