 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Iris I-Lien Wei, DrPH1, Dolly A John, MPH1, and Robert O. Morgan, PhD2. (1) Houston Center for Quality of Care and Utilization Studies, Veterans Affairs Medical Center, 2002 Holcombe Boulevard (Mail stop 152), Houston, TX 77030, 713-794-8648, iwtexas@earthlink.net, (2) Houston Center for Quality of Care and Utilization Studies, Houston VA Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd. (152), Houston, TX 77030
Objectives: Although medical claims data exist for Medicare fee-for-service (FFS) enrollees, the data on use by Medicare HMO enrollees are not readily available. Thus, prior studies of dual Medicare HMO and VA users have focused primarily on the use of VA healthcare system. Little is known about the patterns of total medical care use, VA and non-VA care combined, by Medicare HMO enrolled elderly veterans. Much less is known about gender differences in total medical use by these veterans. The purpose of this study was to assess the impact of Medicare HMO enrollment and gender on self-reported total medical care use by elderly VA using and VA non-using veterans.
Methods: We examined the self-reported medical care use for FFS and HMO enrolled female VA users (N=140), male VA users (N=679), and male veterans who were VA non-users (N=483). Data were collected from a mailed survey of community-dwelling elderly South Florida veterans conducted in 1999 (mean response rate=62%). Random samples were drawn from a combined VA utilization and Medicare enrollment datasets. Medicare HMO enrollment was determined from the Medicare enrollment files. Logistic regressions were used to model the likelihood of self-reported inpatient, outpatient, and emergency room use over the prior 6 months.
Results: After adjusting for co-morbid conditions, reported service-connected disability, age, education, and income we found that among HMO enrolled veterans, female and male VA users were three-fold and two-fold, respectively, more likely than male VA non-users to have one or more ER visits. In addition, male VA users (both FFS and HMO enrolled) were twice more likely to have one or more unscheduled physician visits, while FFS enrolled female and male VA users were twice more likely to report one or more inpatient admissions. No group differences were found in scheduled physician visits.
Conclusions: Among elderly VA users, Medicare HMO enrollment may be associated with a higher likelihood of unplanned medical care (i.e., ER visits and unscheduled physician visits). In contrast, FFS-enrolled female and male VA users were twice more likely to have inpatient admissions. While higher levels of overall unplanned use among dually eligible elderly veterans may ultimately affect the VA’s ability to effectively allocate resources and continue its mission of providing health care to all veterans, it is essential to understand the determinants of utilization among the elderly veterans.
Learning Objectives:
Keywords: Veterans, Medicare
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.