Use of VA services impacted by external economic, policy changes

July 31, 2018

(Boston)--A new study has found that use of VA services is affected by economic and policy changes outside the VA, such as Medicaid eligibility, private employer insurance coverage, unemployment and (non-VA) physician availability.

"As most Veterans live and work in community settings, the choice to use VA health care services is likely influenced by factors both internal and external to the VA. Thus, a better understanding of how these factors influence the choice of VA health care services is important for VA's continued ability to meet Veterans' health care needs," explained corresponding author Amresh Hanchate, PhD, health economist at VA Boston Healthcare System and associate professor of Medicine at Boston University School of Medicine.

The study measured the sensitivity of VA healthcare use to changes in "external determinants" such as unemployment and Medicaid expansion following the Affordable Care Act. The researchers examined VA health care enrollment and utilization data with area-level data on Medicaid policy, unemployment, employer-sponsored insurance, housing prices and non-VA physician availability (2008-2014). Using VA data, they identified more than 8 million Veterans, aged 18 and older, who had either received or were enrolled to receive VA health care during 2008-2014.

The Medicaid expansion following the Affordable Care Act was associated with a 9.1 percent reduction in VA health care utilization among Veterans aged 18-64 in the expansion states ($833 million). Among Veterans aged 18-64, a 10 percent increase in unemployment was associated with 0.65 percent increase in VA health care utilization, while a 10 percent increase in private employer-sponsored coverage was associated with 1.4 percent decrease in VA healthcare utilization. Among Veterans aged 18 and older, increases in (non-VA) physician availability and housing prices were associated with an increase in VA health care utilization. Among Veterans aged 65 and older, a 10 percent increase in housing prices was associated with a 2.2 percent increase in VA health care utilization.

"Our study estimates indicate that the VA utilization change associated with individual external factors is likely small, but specific regions and large policy changes can have a substantial effect. Changes in alternative insurance coverage (Medicaid and private) and other external determinants may affect VA healthcare spending. Policymakers should consider these factors in allocating VA resources to meet local demand," said Hanchate.
-end-
The findings appear in Health Services Research.

This study was funded by VA Health Services Research & Development (IIR 12-338); Dr. Kressin was supported by a VA HSR&D Senior Research Career Scientist Award, and Dr. Linksy was supported by an HSR&D Career Development Award (CDA 12-166). Drs. Hanchate, Kressin, and Linsky are in the Boston University School of Medicine (General Internal Medicine) and part of HSR&D's Center for Healthcare Organization and Implementation Research (CHOIR); Dr. Frakt leads HSR&D QUERI's Partnered Evidence-based Policy Resource Center (PEPReC); and Dr. Trivedi is with HSR&D's Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans.

Boston University School of Medicine

Related Health Care Articles from Brightsurf:

Study evaluates new World Health Organization Labor Care Guide for maternity care providers
The World Health Organization developed the new Labor Care Guide to support clinicians in providing good quality, women-centered care during labor and childbirth.

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

MU Health Care neurologist publishes guidance related to COVID-19 and stroke care
A University of Missouri Health Care neurologist has published more than 40 new recommendations for evaluating and treating stroke patients based on international research examining the link between stroke and novel coronavirus (COVID-19).

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.

International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.

The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .

Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.

High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.

Read More: Health Care News and Health Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.