Study Explores Use of Medicare and VA Healthcare among Veterans with Dementia
Approximately half (48.4%) of the 5.6 million Veterans using the VA healthcare system are 65 and older and are eligible for Medicare. Dual-users (Veterans using more than one healthcare system) are vulnerable to the lack of coordination of care across systems, which can result in either the under-use of appropriate care or excess use of care. These problems are likely to be greater for Veterans with dementia because of the substantial challenges of navigating more than one healthcare system while suffering from this condition. Currently, there are an estimated 175,621 VA patients with dementia, with the number expected to peak at 218,017 in 2017. This study sought to characterize healthcare use among Veterans with dementia over a four-year period (1998-2001), and to determine predictors of whether a Veteran will be a VA-only, dual, or Medicare-only user. Using VA and Medicare data, investigators assessed healthcare use for 2,137 male Veterans who had a formal diagnosis of Alzheimer’s disease or dementia in 1997, and were 65 years and older.
Findings show that during the four-year study period, Medicare-only use increased while VA-only use decreased. In 1998, 41.7% of the Veterans were VA-only users, 55.4% were dual users, and 2.9% were Medicare-only users; however, by 2001, 30.4% of the Veterans were VA-only users, 51.5% were dual users; and 18.1% were Medicare-only users. Results also show that an increased likelihood of some Medicare use was associated with being older, white, married, and having higher education, private insurance or Medicaid, and low VA priority level. Further, the number of functional limitations was associated with an increased likelihood of Medicare-only use and a decreased likelihood of VA-only use, while higher comorbidities were associated with a higher likelihood of dual use as opposed to any single system use. The authors suggest that these results imply that different aspects of Veterans’ needs have differential effects on where Veterans seek care. Efforts to coordinate care between VA and Medicare providers are necessary to ensure patients receive high quality care, particularly among those with multiple comorbidities.
Zhu C, Penrod J, Ross J, Dellenbaugh C, and Sano M. Use of Medicare and VA Healthcare among Veterans with Dementia: A Longitudinal Analysis. Journal of the American Geriatrics Society October 2009;57(10):1908-14.
This study was funded by HSR&D. All authors are part of HSR&D’s Center for Surgical, Medical Acute care Research and Transitions (C-SMART), Bronx, NY.