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Veterans’ Access to and Use of Medicare and Veterans Affairs Health Care

Hynes, Denise M. PhD, RN*†‡; Koelling, Kristin MPH*; Stroupe, Kevin PhD*†§¶; Arnold, Noreen MS*; Mallin, Katherine PhD*; Sohn, Min-Woong PhD†§; Weaver, Frances M. PhD†∥; Manheim, Larry PhD§; Kok, Linda MS*

doi: 10.1097/01.mlr.0000244657.90074.b7
Original Article

Objectives: We examined the impact of access to care characteristics on health care use patterns among those veterans dually eligible for Medicare and Veterans Affairs (VA) services.

Methods: We used a retrospective, cross-sectional design to identify veterans who were eligible to use VA and Medicare health care in calendar year 1999. We analyzed national VA utilization and Medicare claims data. We used descriptive and multivariable generalized ordered logit analyses to examine how patient, geographic, and environmental factors affect the percent reliance on VA and Medicare inpatient and outpatient services.

Results: Of the 1.47 million veterans in our study population with outpatient use, 18% were VA-only users, 36% were Medicare-only users, and 46% were both VA and Medicare users. Among veterans with inpatient use, 24% were VA only, 69% were Medicare only, and 6% were both VA and Medicare users. Multivariable analysis revealed that veterans who were black or had a higher VA priority were most likely to rely on the VA. Patient with higher risk scores were most likely to rely on a combination of VA and Medicare health care. Patients who lived farther from VA hospitals were less likely to rely on VA health care, particularly for inpatient care. Patients living in urban areas with more health care resources were less likely to rely on VA health care.

Conclusions: VA health care provides an important safety net for vulnerable populations. Targeted approaches that carefully consider the simultaneous impacts of VA and Medicare policy changes on minority and high-risk populations are essential to ensure veterans have access to needed health care.

From the *VA Information Resource Center (VIReC), Hines, Illinois; the †Midwest Center for Health Services and Policy Research, Hines, Illinois; the ‡Stritch School of Medicine and Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois; the §Feinberg School of Medicine, Northwestern University, Chicago, Illinois; the ¶Cooperative Studies Program Coordinating Center, Hines, Illinois; and the ∥Department of Neurology, Northwestern University, Chicago, Illinois.

Supported by the Department of Veterans Affairs, Veterans Health Administration Under-Secretary for Health (Project Number: XVA69-01) and the VA Health Services Research and Development Service (Project Numbers: SDR 02-027 and SDR 98-004). Dr. Frances Weaver received funding from the VA Health Services Research and Development Service as a VA Career Scientist during this study.

The views put forth in this article are those of the authors and do not necessarily represent the views of advisory board members or the Department of Veterans Affairs.

Reprints: Denise M. Hynes, PhD, RN, P.O. Box 5000 (151V), Hines, IL 60141. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.