Women in the Veterans Health Administration: Medical conditions, utilization, and costs of care

Phibbs CS, Yu W, Ananth L, Iqbal S, Thrailkill A, Yano E, Frayne S. Women in the Veterans Health Administration: Medical conditions, utilization, and costs of care. Poster session presented at: AcademyHealth Annual Research Meeting; 2005 Jun 1; Boston, MA.

Research Objective: Historically, men have constituted the vast majority ofVeterans Health Administration (VA) patients. With growing numbers of womenveterans receiving care in VA, a systematic assessment of their medicalprofile was needed to guide innovations in VA's approach to women's healthcare. This study examined whether disease burden, utilization and costs ofVA care differ in women veterans, compared to male veteran VA patients. Study Design: Cross-sectional study using fiscal year 2002 centralized VAadministrative and clinical files. [Patients with missing gender, age,veterans status, or costs of care were excluded.] A modified version ofAHRQ's Clinical Classifications Software was used to describe the clinicalconditions of patients. Descriptive statistics were used to comparepatients by gender and veterans status. Logistic regressions were used toestimate the age-adjusted odds ratios (OR) of the clinical conditions inwomen veterans versus male veterans. Mean health care utilization and costswere compared by gender and the presence and absence of medical and mentalhealth conditions. Linear regression was used to compare differences inutilization and costs by gender, controlling for age and clinicalconditions. Population Studied: All (N = 4,444,577) users of VA care in FY 2002. Themain analyses focused on the 178,463 women veterans and 3,940,148 maleveterans who used VA care, We also characterized [the] conditions innon-veteran women (N = 185,040). Principal Findings:Half of the women who received VA care were not veterans, compared to only3% of males. Among veterans, women were younger, less likely to be married,and more likely to have a service-connected disability. Chronic conditionswere common in both men and women veterans with some differences inprevalence. Several conditions were more common in women than in men, mostnotably osteoporosis (age-adjusted OR 13.6). Mean total annual outpatientencounters per patient was 16.9 for veteran women and 15.1 for veteran men.Mean total annual inpatient days per patient was 1.9 days for women veteransand 2.5 days for male veterans. Mean total annual cost per patient was$3,941 for veteran women and $4,446 for veteran men. Adjusting for age andmedical conditions, women veterans had 1% more outpatient encounters, 11%fewer inpatient days, and 3% less total cost. Among veterans with bothmedical and mental health conditions, women used outpatient services moreheavily. [do you want p value or CI on any of these?] Conclusions: There are substantial gender differences in [the] conditions,utilization and costs for patients receiving VA care. But, after accountingfor differences in age and clinical conditions, the VA costs and utilizationare similar across genders. Researchers using VA data need to be carefulabout non-veterans in the data, especially among women. Implications for Policy, Delivery or Practice: VA's efforts to buildcapacity for the growing women veteran population must account for thespectrum of medical conditions seen in this special population, which crossthe life span and include both gender-specific and gender-neutral diseases.To meet the needs of the subset of women veterans with comorbid medical andmental health conditions, who represent high intensity users of outpatientservices, delivery systems integrating ambulatory medical and mental healthcare deserve attention.