3050 — Self-Reported Characteristics of Veterans Who Use the VA and Medicare

Keyhani S (James J. Peters Bronx VAMC/Mount Sinai School of Medicine), Allen VD (James J. Peters Bronx VAMC), Penrod JD (James J. Peters Bronx VAMC/Mount Sinai School of Medicine), Hebert PL (VA Puget Sound), Zhu CW (James J. Peters Bronx VAMC/Mount Sinai School of Medicine), Siu AL (James J. Peters Bronx VAMC/Mount Sinai School of Medicine)

Objectives:
Previous research using administrative data has found that higher-risk veterans use the VA. We built on this research by using survey data to compare the characteristics of veterans who use the VA compared to veterans who use Fee-for-Service (FFS) Medicare or Medicare HMOs.

Methods:
We identified 4880 veterans using pooled cross-sectional data from the Medicare Current Beneficiary Survey (MCBS) for the years 1998-2002. We used expenditure data to classify veterans as Medicare FFS-only users, Medicare HMO-only users, dual VA-Medicare users, and VA-only users. We verified use of VA services using VA data. We used multivariable logistic regression analyses to compare the socio-demographic and self-reported health characteristics of VA users compared to Medicare users.

Results:
Among the 4330 veteran identified, 15.6% were VA-only users, 63.9% were Medicare FFS-only users, 13.2% were Medicare HMO users, and 7.15% were dual VA-Medicare users. We found no significant differences between VA-only users and VA-Medicare duals users, and combined this group. In multivariable analysis, compared to veterans who were Medicare FFS users, VA users were more likely to be black or hispanic. Veteran users were less likely to have supplemental private insurance [OR 0.75, 95% CI (0.64, 0.870)] were more likely to live alone [OR 1.36, 95% CI (1.00, 1.84)], and less likely to be married. Veteran users were more likely to be low income ( < $25,000) [OR 1.84, 95% CI (1.57, 2.17)]. Veterans who used the VA more commonly reported coronary artery disease [OR 1.32, 95% CI (1.12, 1.55)], diabetes [OR 1.22, 95% CI (1.01, 1.47)], chronic obstructive pulmonary disease [OR 1.24, 95% CI (1.01, 1.53)] and arthritis [OR 1.25, 95% CI (1.07, 1.46)]. Veterans with self-reported good, very good, or excellent health care status were less likely to be VA users [OR 0.73, 95% CI (0.60, 0.88)]. Veterans who used Medicare HMOs were more similar to veterans who used Medicare FFS than veterans who used the VA.

Implications:
The VA attracts veterans who are low income, isolated, and in poor health.

Impacts:
Despite the availability of Medicare coverage, the VA serves as a safety net for vulnerable elderly veterans.