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Veterans Using and Uninsured Veterans Not Using VA Health Care Karin Nelson, MD, MSHS Gordon A. Starkebaum, MD Gayle E. Reiber, PhD, MPH VA Puget Sound Health Care System Department of Medicine, University of Washington Departments of Health Services and Epidemiology, University of Washington Seattle, WA
Background • Department of Veterans Affairs (VA) is the largest integrated health care system in the US • Entry into the VA based on military service-related conditions, disability or financial need • Some veterans who are uninsured do not seek care despite eligibility for VA coverage
Background • Veterans can receive VA and non-VA care in both outpatient and inpatient settings • VA data systems capture encounters within VA system • Extent of other health care use has been hard to quantify, especially among veterans less than 65 years of age
Study Objectives • Describe the characteristics of veterans who receive all or some of their care through the VA • Describe other sources of health care coverage for veterans • Describe uninsured veterans (no health insurance and no use of VA services)
Methods • Data from 2000 Behavioral Risk Factor Surveillance System (BRFSS) • cross sectional telephone survey • civilian, non-institutionalized population • state specific probability sample of households • 2000 BRFSS only year with both veteran and health insurance questions
Study population n=184,450 BRFSS interviewed individuals n=26,265 served in US Armed Forces n=23,880 not active military service n=23,797 veterans responded to questions about use of VA health care facilities
Measures • Health insurance coverage • Demographics: age, gender, race/ethnicity, education, annual income • Health care access • Time since last health care visit • Couldn’t afford a doctor visit in the past year • Health status • Disability: mental and physical health • Tobacco use
Data Analysis • Bivariate analysis to describe the differences in socioeconomic characteristics, health status and health care access by use of VA services • Multivariate analysis to assess the independent association of socioeconomic status and receiving all care at the VA
Adjusted odds of veterans receiving all health care at the VA Adjusted for age and gender
Type of health care coverage by use of VA care among veterans <65 yrs p<0.001
Characteristics of uninsured veterans, % *p<0.001, † p<0.05
Limitations • Self report • Suboptimal response rate • Does not include individuals without phones, homeless individuals or those living in institutions • Measures health insurance at one point in time • Does not assess enrollment in VA system or VA eligibility
Conclusions • Veterans who utilize the VA for all of their health care are more likely to be disabled and from disadvantaged groups • A large number of veterans who could use VA services are uninsured • Potential enrollment target given the detrimental effects of being uninsured