Dual use of Medicare and the Veterans Health Administration: are there adverse health outcomes?

Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Mortality* ; Outcome Assessment, Health Care* ; Risk Assessment*; Deductibles and Coinsurance/*statistics & numerical data ; Hospitals, Veterans/*statistics & numerical data ; Medicare/*statistics & numerical data ; Veterans/*statistics & numerical data; Aged ; Aged, 80 and over ; Episode of Care ; Health Services Research ; Hospitals, Veterans/standards ; Humans ; Male ; Medicare/standards ; Proportional Hazards Models ; Quality Indicators, Health Care ; Selection Bias ; Surveys and Questionnaires ; United States/epidemiology ; United States Department of Veterans Affairs

Background: Millions of veterans are eligible to use the Veterans Health Administration (VHA) and Medicare because of their military service and age. This article examines whether an indirect measure of dual use based on inpatient services is associated with increased mortality risk.
Methods: Data on 1,566 self-responding men (weighted N = 1,522) from the Survey of Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to Medicare claims and the National Death Index. Dual use was indirectly indicated when the self-reported number of hospital episodes in the 12 months prior to baseline was greater than that observed in the Medicare claims. The independent association of dual use with mortality was estimated using proportional hazards regression.
Results: 96 (11%) of the veterans were classified as dual users. 766 men (50.3%) had died by December 31, 2002, including 64.9% of the dual users and 49.3% of all others, for an attributable mortality risk of 15.6% (p < .003). Adjusting for demographics, socioeconomics, comorbidity, hospitalization status, and selection bias at baseline, as well as subsequent hospitalization for ambulatory care sensitive conditions, the independent effect of dual use was a 56.1% increased relative risk of mortality (AHR = 1.561; p = .009).
Conclusion: An indirect measure of veterans' dual use of the VHA and Medicare systems, based on inpatient services, was associated with an increased risk of death. Further examination of dual use, especially in the outpatient setting, is needed, because dual inpatient and dual outpatient use may be different phenomena.

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R01 AG022913 United States AG NIA NIH HHS; R03 AG027741 United States AG NIA NIH HHS

Date Created: 20061013 Date Completed: 20070105 Latest Revision: 20240508

20250114

PMC1617101

10.1186/1472-6963-6-131

17029643