Address correspondence to Kathleen Carey, Ph.D., VA Center for Health Quality, Outcomes and Economic Research and, Boston University School of Public Health, 200 Springs Road, Bedford MA 01730. E-mail: firstname.lastname@example.org. Maria E. Montez-Rath, M.S., Boston University School of Public Health, Mountain View, CA. Amy K. Rosen, Ph.D., Cindy L. Christiansen, Ph.D., and Susan Loveland, M.A.T., are with the VA Center for Health Quality, Outcomes and Economic Research and Boston University School of Public Health, Bedford, MA. Susan L. Ettner, Ph.D., is with the Division of General Internal Medicine and Health Services Research, Department of Medicine, and the Department of Health Services, University of California, Los Angeles, CA.
Use of VA and Medicare Services By Dually Eligible Veterans with Psychiatric Problems
Version of Record online: 17 MAR 2008
© Health Research and Educational Trust
Health Services Research
Volume 43, Issue 4, pages 1164–1183, August 2008
How to Cite
Carey, K., Montez-Rath, M. E., Rosen, A. K., Christiansen, C. L., Loveland, S. and Ettner, S. L. (2008), Use of VA and Medicare Services By Dually Eligible Veterans with Psychiatric Problems. Health Services Research, 43: 1164–1183. doi: 10.1111/j.1475-6773.2008.00840.x
- Issue online: 16 JUL 2008
- Version of Record online: 17 MAR 2008
- mental health and substance abuse
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.