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Publication Briefs

More than Half of Privately Insured Veterans Younger than 65 Years of Age Access both VA and Non-VA Healthcare

The Veterans Choice Act and other recent initiatives provide increasing opportunities for Veterans residing in rural settings and who are enrolled in VA healthcare to access non-VA providers. Further, Veterans returning from recent deployment have high priority for VA healthcare services that lasts five years post-discharge, regardless of service-connected disabilities or income. Priority access to VA care and possible increased access to non-VA care raise concerns about healthcare coordination. This study sought to quantify use of VA and non-VA care among working-age Veterans with private insurance by linking VA data to private health insurance plan (PHIP) data. Investigators identified 16,330 Veterans under age 65 who resided in two Midwestern states, and were simultaneously enrolled in both VA healthcare and PHIP for at least one fiscal year between October 2000 and September 2010. Using VA and PHIP data, investigators compared demographics and healthcare use between the two systems.


  • More than half (54%) of Veterans younger than 65 who were enrolled in both VA and private health insurance plans accessed both healthcare systems; 39% used non-VA healthcare only, while 5% used VA healthcare only.
  • Dual system users had the lowest percentage of Veterans under age 40 (15%) and the highest percentage of Veterans over age 50 (71%), while VA-only users had the highest percentage of Veterans under age 40 (22%) and the lowest percentage of Veterans over age 50 (61%). Dual system users also had the highest proportion of Veterans residing in rural settings (61%).
  • VA reliance was 33% for outpatient care, 14% for inpatient care, and 40% for pharmacy.
  • PHIP data substantially underestimated VA use compared to VA data: 26% of Veterans who used VA healthcare had no VA claims in the PHIP dataset, likely due to either Veterans failing to disclose their private health insurance plan or to inconsistent billing to the private plan by VA providers.


  • Findings suggest that care coordination efforts for Veterans across age groups should include privately insured Veterans under age 65 in order to ensure safe and coordinated care. Care coordination efforts should aim to increase awareness of dual use among VA and community providers, and future research should assess potential geographic variation in dual use patterns.


  • PHIP claims could not be directly linked to VA encounter-level data in order to validate consistency in utilization counts across data sets due to privacy concerns.
  • This study focused primarily on two rural areas in the Midwest and findings may not be representative of other geographic areas that include more urban centers.
  • Study data are presented only up to 2010, thus other potential contributing factors (e.g., Affordable Care Act implementation) were not considered.

This study was funded by HSR&D (IIR 11-319). Drs. Charlton, Mengeling, and Turvey are part of HSR&D's Center for Comprehensive Access & Delivery Research and Evaluation.

PubMed Logo Charlton M, Mengeling M, Schlichting J, Jiang L, Turvey C, Trivedi A, Kizer K, and West A. Veteran Use of Health Care Systems in Rural States: Comparing VA and Non-VA Health Care Use among Privately Insured Veterans Under Age 65. The Journal of Rural Health. September 2016;32(4):407-17.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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