3114 — VA Users also Use Non-VA Care Heavily, but Rural Veterans Rely Increasingly on the VA

West AN (White River Jct VAMC)

Objectives:
To compare medical expenditures for veterans in VA care with other healthcare-using veterans and non-veterans, assessing the effects of age and rural residence.

Methods:
Subjects included all healthcare-using adult males (N=25,691) in any of nine years (1996-2004) of the national Medical Expenditures Panel Survey, separated into: a) veterans who used any VA healthcare, veterans who did not, or non-veterans; b) veterans younger or older than 65; and c)those living in urban or rural areas. Analyses of their annual medical expenditures applied population weights, accounted for survey design (PSUs and strata) to yield appropriate standard errors, and controlled for demographic, health status, and insurance coverage covariates. Trends over time were assessed with linear regressions.

Results:
Regardless of residence, VA users younger than 65 had average annual medical expenditures about $2500 higher than other veterans or non-veterans their age; among older men, VA users averaged $1500+ more than others (all p’s < .0001). But the VA portion averaged only about 15-20% of VA users’ total expenditures; even among veterans who used at least $1000 of VA care per year, VA averaged less than half of their total medical care. For VA users (as for other men) older than 65, Medicare paid more than half their expenditures, but private insurance and self/family payments also were substantial. Private insurance paid the most for men younger than 65, even VA users. Despite their comparable health needs, rural VA users averaged $1100 less in medical care than urban VA users (p < .0001), mostly due to lower payments by insurance. From 1996 through 2004, the proportion of veterans who used any VA care increased from less than 30% to nearly 50%. Veterans in either age group were more likely to use VA care if they were rural residents; rural veterans older than 65 were the most likely to use any VA care, or to use at least $1000 of it, in any year. For rural VA users younger than 65, VA has provided a steadily increasing percent of their medical care in recent years (to above 40% of all expenditures in 2004), whereas for other users this percentage has been more stable at around 25%.

Implications:
VA’s share of the healthcare market for veterans has increased, particularly among rural residents, but it still provides less than half of their total care on average. Among men younger than 65, rural veterans are at a disadvantage for lack of adequate private insurance coverage.

Impacts:
To better meet the medical needs of rural enrollees, VA might consider additional support to enhance their access to non-VA care.