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Needs of Women Veterans Must be Carefully Considered in Building Tomorrow's VHA

Women have served in the U.S. military since our country's birth. However, as a numeric minority in VA, they received little special attention until the 1990s, when multiple clinical programs were launched. Research on the health care needs of women veterans grew during the same period, but did not keep pace with this service expansion.

Therefore, in 2004, as part of a VA-wide initiative of the VA Office of Research & Development, experts from around the country participated in development of a women veterans' health research agenda, designed to ensure that VA is positioned to provide high quality, evidence-based care to this rapidly growing population.¹ The agenda identified an important next step: taking stock of the health care needs of women veterans, benchmarked against male veterans. In response, the research described here used VA's 2002 National Patient Care Database to characterize gender differences in diagnoses, utilization, and cost of VA care at a macro level.

Not All Women VA Patients are Veterans

Surprisingly, this analysis found that half the women who use VA are not veterans.² Employees constitute the biggest group of non-veterans. Other non-veteran women who use VA include those eligible under Tricare or CHAMPVA. Since non-veteran status is far more common in women than in men, it is important to account for veteran status in gender disparities research; if non-veterans are included, the female sample is disproportionately enriched with a healthy group of low utilizers (e.g., employees VA investigators doing gender research need to decide up front whether their research question calls for inclusion of nonveterans, and ensure their methods account for this issue. As a result, the researchers decided to limit the focus of their work to veteran VA patients.

Characteristics of Women Veteran VA Patients

Since women are joining the military in increasing numbers, it made sense that women veteran VA patients were on average younger than their male counterparts: 43 percent of women versus 9 percent of men were under age 45.³ Despite their younger age, the majority of women veteran VA patients, like male veterans, suffer from at least one chronic medical condition (74 percent of women, 79 percent of men). More women veterans than male veterans, however, had a mental health condition (38 percent vs. 30 percent). Within every age stratum, women used VA outpatient services more heavily than did men, and at higher cost, although the magnitude of difference was small after adjusting for age and medical conditions. The 31 percent of women who had both medical and mental health conditions had the highest health care utilization and costs of care. Indeed, while women overall averaged 17 outpatient encounters per year, the subgroup with comorbid medical and mental illness averaged 31.

Using broad strokes, this research paints a picture of women veteran VA patients as a group with a heavy illness burden, frequent outpatient utilization, and substantial costs of care. Male veteran VA patients are known to be sicker than men in the general population. These findings suggest that the women veterans we serve are likely to require a comparable intensity of care.

Research Gaps Remain

Subsequent work will need to fill in the finer details of this picture, such as: Where should we focus efforts to improve quality of care, so as to have the greatest impact? What health care delivery systems most effectively address the health care needs of women veterans? Do findings apply to women veterans who do not use VA? Investigators will be able to pursue these questions because VA HSR&D has made women veterans' health a major focus. For example, HSR&D partnered with the Journal of General Internal Medicine to create a special women veterans issue in 2006. VA HSR&D has distributed special solicitations in women's health, and encourages grant reviewers to note whether even projects without a women's health focus include women and, if feasible, characterize findings by gender. Women's health is one of the 11 special focus areas overseen by a specific portfolio manager.

All of these initiatives point to VA HSR&D's commitment to expanding the knowledge base upon which our clinical care of women veterans rests. Women are joining VA in rapidly increasing numbers. There is a pressing demand for VA investigators to address gaps in this field so as to respond to women's needs today and better prepare for the VA of tomorrow.

References

1. Yano EM, et al. Toward a VA Women's Health Research Agenda: Setting Evidence-based Priorities to Improve the Health and Health Care of Women Veterans. Journal of General Internal Medicine 2006; 21(s3):S93-S101.
2. Frayne SM, et al. Gender Disparities in Veterans Health Administration Care: Importance of Accounting for Veteran Status. Medical Care 2008; 46(5):549-53.
3. 3. Frayne SM, et al. Gender and Use of Care: Planning for Tomorrow's Veterans Health Administration. Journal of Women's Health 2007; 16(8):1188-99.