Journal article
Insured Veterans' Use of VA and Non-VA Health Care in a Rural State
The Journal of rural health, Vol.32(4), pp.387-396
09/2016
DOI: 10.1111/jrh.12196
PMID: 27481190
Abstract
To understand how working-age VA-enrolled veterans with commercial insurance use both VA and non-VA outpatient care, and how rural residence affects dual use, for common diagnoses and procedures.
We analyzed VA and non-VA outpatient treatment records for any months during 2005-2010 that New Hampshire veterans ages <65 were simultaneously enrolled in VA health care and commercial insurance (per NH's mandatory claims database). Controlling for covariates, we used analysis of variance to compare urban and rural VA users, non-VA users, and dual users on travel burden, diagnosis counts, duration in outpatient care, and visit frequencies, and logistic regressions to assess whether rural veterans were as likely to be seen for common conditions and procedures.
More than half of patients were non-VA users and another third were dual users; rural residents were slightly more likely than urban residents to be dual users. For nearly any common diagnosis or procedure, dual users were more likely to have it at some time during treatment than other patients in either VA or non-VA care, but they seldom had it listed in both care systems. Dual users also were seen most often overall, although within either care system they were seen less often than other patients, particularly if they were rural residents living far from care. Rural residence reduced chances of treatment for a wide variety of conditions, though it also was associated with more musculoskeletal and connective tissue diagnoses. It also reduced chances that patients had some diagnostic and treatment procedures but increased the odds of others that may require fewer visits.
Dual users living in rural areas may have less continuity in their health care. Ensuring that rural dual users are identified in primary care should improve access and care coordination.
Details
- Title: Subtitle
- Insured Veterans' Use of VA and Non-VA Health Care in a Rural State
- Creators
- Alan N West - Office of Rural Health, Veterans Health Administration, Washington, DC. alan.west@va.govMary E Charlton - Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- The Journal of rural health, Vol.32(4), pp.387-396
- Publisher
- England
- DOI
- 10.1111/jrh.12196
- PMID
- 27481190
- ISSN
- 0890-765X
- eISSN
- 1748-0361
- Grant note
- DOI: 10.13039/100007217, name: Health Services Research and Development, award: IIR 07–233, IIR 11–319
- Language
- English
- Date published
- 09/2016
- Academic Unit
- Health Management and Policy; Epidemiology
- Record Identifier
- 9983995112502771
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