Address correspondence to Alan N. West, Ph.D., Veterans Rural Health Resource Center – Eastern Region, White River Junction VA Medical Center, White River Junction, VT; and the VA Outcomes Group Research Enhancement Award Program, White River Junction VA Medical Center, White River Junction, VT; email: alan.west@va.gov. William B. Weeks, M.D., M.B.A., is with the VA Outcomes Group Research Enhancement Award Program, White River Junction VA Medical Center, White River Junction, VT; and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
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Health Care Expenditures for Urban and Rural Veterans in Veterans Health Administration Care
Article first published online: 3 JUN 2009
DOI: 10.1111/j.1475-6773.2009.00988.x
© Health Research and Educational Trust
Additional Information
How to Cite
West, A. N. and Weeks, W. B. (2009), Health Care Expenditures for Urban and Rural Veterans in Veterans Health Administration Care. Health Services Research, 44: 1718–1734. doi: 10.1111/j.1475-6773.2009.00988.x
Publication History
- Issue published online: 1 SEP 2009
- Article first published online: 3 JUN 2009
Keywords:
- Veterans;
- rural;
- expenditures
Objective. To compare Veterans Health Administration (VA) patients, non-VA-using veterans, and nonveterans, separated by urban/rural residence and age group, on their use of major categories of medical care and payment sources.
Data Source. Expenditures for health care–using men in Medical Expenditure Panel Surveys from 1996 through 2004.
Study Design. Retrospective, cross-sectional analysis.
Data Collection/Extraction Methods. Controlling for demographics, health status, and insurance, we compared groups on population-weighted expenditures for inpatient, hospital-based outpatient, office-based, pharmacy, and other care, by major payers (self/family, private insurance, Medicare, other sources, and VA).
Results. VA users received most of their health care outside of the VA system, paid through private insurance or Medicare; self-payments were substantial. VA users under 65 reported worse health if they were rural residents but also lower expenditures overall and less care through private insurance.
Conclusions. VA health care users get most of their medical care from non-VA providers. Working-age VA users have less insurance coverage and rely more on VA care if they live in rural areas.