Use of VA and Medicare services by dually eligible veterans with psychiatric problems

Health Serv Res. 2008 Aug;43(4):1164-83. doi: 10.1111/j.1475-6773.2008.00840.x. Epub 2008 Mar 17.

Abstract

Objective: To examine how service accessibility measured by geographic distance affects service sector choices for veterans who are dually eligible for veterans affairs (VA) and Medicare services and who are diagnosed with mental health and/or substance abuse (MH/SA) disorders.

Data sources: Primary VA data sources were the Patient Treatment (acute care), Extended Care (long-term care), and Outpatient Clinic files. VA cost data were obtained from (1) inpatient and outpatient cost files developed by the VA Health Economics and Resource Center and (2) outpatient VA Decision Support System files. Medicare data sources were the denominator, Medicare Provider Analysis Review (MEDPAR), Provider-of-Service, Outpatient Standard Analytic and Physician/Supplier Standard Analytic files. Additional sources included the Area Resource File and Census Bureau data.

Study design: We identified dually eligible veterans who had either an inpatient or outpatient MH/SA diagnosis in the VA system during fiscal year (FY)'99. We then estimated one- and two-part regression models to explain the effects of geographic distance on both VA and Medicare total and MH/SA costs.

Principal findings: Results provide evidence for substitution between the VA and Medicare, demonstrating that poorer geographic access to VA inpatient and outpatient clinics decreased VA expenditures but increased Medicare expenditures, while poorer access to Medicare-certified general and psychiatric hospitals decreased Medicare expenditures but increased VA expenditures.

Conclusions: As geographic distance to VA medical facility increases, Medicare plays an increasingly important role in providing mental health services to veterans.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Diagnosis, Dual (Psychiatry)
  • Eligibility Determination
  • Female
  • Health Expenditures / statistics & numerical data
  • Health Services Accessibility / economics
  • Health Services Accessibility / statistics & numerical data*
  • Hospitals, Veterans / economics
  • Hospitals, Veterans / statistics & numerical data*
  • Humans
  • Male
  • Medicare / economics
  • Medicare / statistics & numerical data*
  • Mental Disorders / economics
  • Mental Disorders / epidemiology*
  • Mental Disorders / therapy
  • Mental Health Services / statistics & numerical data*
  • Middle Aged
  • Outcome Assessment, Health Care
  • Residence Characteristics
  • Substance-Related Disorders / economics
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / therapy
  • United States
  • United States Department of Veterans Affairs
  • Veterans / statistics & numerical data*