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
„
„
„
Veterans can receive VA and nonnon-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
Methods
„
Data from 2000 Behavioral Risk Factor
Surveillance System (BRFSS)
– cross sectional telephone survey
– civilian, nonnon-institutionalized population
– state specific probability sample of households
„
2000 BRFSS only year with both veteran
and health insurance questions
Background
„
„
„
Department of Veterans Affairs (VA) is the
largest integrated health care system in the US
Entry into the VA based on military serviceservicerelated conditions, disability or financial need
Some veterans who are uninsured do not seek
care despite eligibility for VA coverage
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)
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
1
Data Analysis
Measures
„ Health
„
„
insurance coverage
„
Demographics: age, gender, race/ethnicity,
education, annual income
Health care access
„
– Time since last health care visit
– Couldn’
Couldn’t afford a doctor visit in the past year
„
„
„
Health status
Disability: mental and physical health
Tobacco use
Veteran Characteristics by use
of VA services
Adjusted odds of veterans
receiving all health care at the VA
All VA Some
No VA
Care VA care care
%
n=1,647
n=1,744
n=20,406
Age > 65
White
African American
Hispanic
Annual Income < $15,000
> 8 disability days/month
36
74
15
8
23
19
47
75
13
9
14
18
36
85
7
5
6
7
*
Fair or poor health status
37
33
16
*
*
*
*
* p<0.001
Type of health care coverage by use of VA
care among veterans <65 yrs
%
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
All care at the Some care
No VA
VA
at the VA
care
n=435
n=669
n=12,835
Private insurance
42.6
67.3
83.2
Medicare
36.3
21.4
5.2
Medicaid or IHS
1.8
1.3
1.3
Other insurance
5.4
1.4
1.7
No insurance
13.8
8.6
8.6
p<0.001
Population characteristic
OR
95% CI
African American
Hispanic
White
Annual income <$15,000
$15-35,000
>$35,000
< High School education
High School education
College
1.8
1.3
1.3, 2.4
0.8, 2.2
Reference
6.3
2.9
4.6, 8.7
2.3, 3.8
Reference
2.4
1.6
1.6, 3.4
1.2, 2.1
Reference
Adjusted for age and gender
Characteristics of uninsured veterans, %
Uninsured
veterans
Population estimate
1,324,040
Sample size
1,216
55.9
Age 1818-45 years
41.2
4646-64 years
8.7
Female
78.1
White
10.0
African American
9.4
Hispanic
16.0
Annual Income < $15,000
54.5
$15,000$15,000-35,000
36.7
Could not afford MD/past yr
Veterans with
insurance
25,877,256
20,953
21.3 *
39.7
5.2 †
84.3 †
7.8
5.3
6.9 *
31.8
4.8 *
*p<0.001, † p<0.05
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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
3