Increasing Number of Women Veterans Use VA Maternity Benefits
BACKGROUND:
An increasing number of young women Veterans are returning from military service seeking reproductive healthcare within the VA healthcare system. Maternity benefits have been included in the VA medical benefits package since 1996. However, because women remain a minority in the VA healthcare population, most VA facilities do not provide prenatal care, and nearly all maternity care is provided by community-based obstetrical providers through the VA fee-basis care program. Moreover, VA only recently extended insurance benefits to the newborn infants of women Veterans to include up to seven days of medical care for newborns. This retrospective cohort study examined the number and cost of inpatient deliveries in VA over a five-year period – from FY2008 to FY2012 (n=9,225 women).
FINDINGS:
- From FY2008 to FY2012, the volume of women Veterans using VA maternity benefits increased by 44% – from 12.4 to 17.8 deliveries per 1,000 women Veterans. Also, the number of deliveries increased during each year – from 1,442 delivery claims in FY2008 to 2,730 in FY2012.
- A majority of women using VA maternity benefits were age 30 and older, resided in urban areas (72%), and had a service-connected disability. Also, 42% were OEF/OIF/OND Veterans.
- Over the five-year study period, VA paid more than $46 million in delivery claims to community providers for deliveries of women Veterans ($4,993 per Veteran).
- The rate of C-section delivery was 34%, which is similar to the national average of 32%.
LIMITATIONS:
- This study only examined births using VHA maternity benefits. It did not examine births to women Veterans using private insurance or Medicaid.
- Investigators were unable to control for time effects, including the increasing number of OEF/OIF/OND women Veterans and underlying upward trends in the use of VA maternity benefits.
IMPLICATIONS:
- Given the sizeable increase in delivery rates, the authors suggest that VA increase its capacity for pregnant Veterans and ensure care coordination systems are in place to address the needs of pregnant Veterans with service-connected disabilities. Coordinating community-based maternity care with ongoing VA care is critical because many women Veterans have complex medical and mental health conditions that may increase their risk of adverse pregnancy outcomes.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (CRE 12-008). Dr. Mattocks is part of the VA Central Western Massachusetts Healthcare System. Dr. Frayne is part of HSR&D's Center for Innovation to Implementation: Fostering High Value Care, Palo Alto, CA. Dr. Phibbs is part of HSR&D's Health Economics Resource Center, Palo Alto.
Mattocks K, Frayne S, Phibbs C, et al. Five-Year Trends in Women Veterans’ Use of VA Maternity Benefits (2008-2012). Women’s Health Issues January 2014;24(1):e37-e42.
