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Health Services Research & Development

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VA Enrollees' Health Insurance Coverage

Shen Y, Hendricks A, Zhang S, Kazis L. VA Enrollees' Health Insurance Coverage. Paper presented at: VA HSR&D National Meeting; 2001 Feb 15; Washington, DC.

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Objectives: Prior national surveys of veterans found significant public and private insurance coverage among VA patients. In the 1990s, insurance coverage may have changed as the veteran population aged and economy boomed. Using the 1999 survey of VA patients, we determined the levels of public and private insurance coverage for VA enrollees and their variation across sub-populations. We compared the results with those based on the National Survey of Veterans in 1992. We also assessed variations in insurance coverage across VISNs. Methods: We used data from the insurance module (n = 152,258) of the '1999 Large Health Survey of Veteran Enrollees' (response rate of 63%) to assess insurance coverage. Based on self-reports, we grouped individuals as: 1) no alternative coverage; 2) Medicare; 3) private insurance without Medicare; and 4) Medicaid only. For the Medicare subsample, we identified Medigap supplements, HMO enrollment and basic coverage (part A and/or B). The insurance distributions were further stratified by VISN and individual characteristics (priority status, health status measured by SF-36 physical (PCS) and mental (MCS) summary scores, gender, ethnicity, employment, and marital status). Population estimates used both a response weight and a sampling weight. Results: About 27% of VA enrollees had no alternative coverage, compared to 21% in 1992. This proportion varied by a factor of 2: from 19% in VISN 3 to 37.9% in VISN 22. Medicare was the major (53%) alternative coverage for VA enrollees. This proportion varied from 42.1% in VISN 20 to 62.1% in VISN 3. Variations are mainly due to the difference in the distribution of the elderly population by VISNs. Elderly VA enrollees ( > = 65) are eligible for Medicare (correlation of % elderly to % Medicare = 0.96) and VISNs with fewer enrollees on Medicare have more enrollees without alternative coverage (correlation of % elderly to % uninsured = -0.84). Alternative coverage may not cover all health care cost. For example, 41.4% of VA-Medicare dual enrollees have only basic Medicare coverage. This proportion varies by VISN. Insurance coverage differs by individuals' characteristics. For example, VA enrollees catastrophically disabled, with service-connected disability 50%+ or with low income are more likely than other enrollees to have no coverage or only basic Medicare coverage.Conclusions: Over time, the proportion of uninsured VA enrollees has increased and dual Medicare-VA enrollment has grown. The variation of uninsured enrollees across VISNs is associated with the variations in the distribution of elderly patients. Individuals' characteristics are associated with their insurance coverage. Impacts: As the veteran population ages, the VA's health care mission has changed to provide greater chronic and long term care. Older veterans now have more options for care, but many still rely on VA to fill gaps from other coverage. The knowledge about VA enrollees' insurance coverage can help VA better manage and finance care, improve VA's coordination of benefits of VA enrollees.

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