Increased Health Care Utilization and Costs Among Veterans With a Positive Screen for Military Sexual Trauma.

Brignone E, Gundlapalli AV, Blais RK, Kimerling R, Barrett TS, Nelson RE, Carter ME, Samore MH, Fargo JD. Increased Health Care Utilization and Costs Among Veterans With a Positive Screen for Military Sexual Trauma. Medical care. 2017 Sep 1; 55 Suppl 9 Suppl 2:S70-S77.

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Abstract:

BACKGROUND: The effects of sexual trauma on long-term health care utilization and costs are not well understood due to infrequent documentation of sexual trauma history in health care systems. The Veteran''s Health Administration provides a unique opportunity to address this constraint as sexual trauma is actively screened for as part of routine care. METHODS: We used a retrospective cohort design to analyze Veteran''s Health Administration mental health and medical service utilization and costs as a function of a positive screen for exposure to military sexual trauma (MST) among Veterans of recent conflicts in Iraq and Afghanistan. We computed adjusted 5-year estimates of overall utilization and costs, and utilization and costs determined not to be related to MST. RESULTS: The cohort included 426,223 men and 59,611 women. A positive MST screen was associated with 50% higher health care utilization and costs relative to a negative screen. Overall, a positive relative to negative MST screen was associated with a 5-year incremental difference of 34.6 encounters and $10,734 among women, and 33.5 encounters and $11,484 among men. After accounting for MST-related treatment, positive MST screen was associated with 11.9 encounters and $4803 among women, and 19.5 encounters and $8001 among men. CONCLUSIONS: Results demonstrate significant and consistent differences in health care utilization and costs between Veterans with a positive relative to negative MST screen. Even after accounting for MST-related care, a positive screen was associated with significantly higher utilization and costs. MST-related needs may be more readily recognized in women relative to men.