Private health insurance and veterans use of Veterans Affairs care. RATE Project Committee. Rate Alternative Technical Evaluation.
OBJECTIVE
This study examined the effect of private health insurance on the use of medical, surgical, psychiatric, and addiction services for patients eligible for publicly supported care.


METHODS
The authors assembled administrative databases describing 350,000 noninstitutionalized veterans who had been discharged from a Veterans Affairs (VA) inpatient medicine or surgery bed section during a 1-year period. Patient use of care was followed for 1 year after the index discharge. Patient insurance information came from Medical Care Cost Recovery Billing and Collection files obtained separately from each of 162 VA Medical Centers. Distances between VA and non-VA sources of care were estimated from the Health Care Financing Administration's Hospital Distance File.


RESULTS
Insured patients were less likely to seek surgical care but were 12 times (65 years of age and older) and 73 times (63 years of age and younger) more likely to initiate outpatient medical visits than were their counterparts, adjusted for patient demographic, diagnostic, and index facility characteristics. Patients who had private health insurance also were 3.4 (> or = 65) and 2.6 (< or = 64) times less likely to use VA surgical care in response to changes in available surgical staff-to-patient ratios than were their uninsured counterparts.


CONCLUSIONS
Private health insurance may substitute (reduce) or complement (increase) the continued use of publicly supported health care services, depending on patient age, care setting, and service type.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas VA Center for Health Services Research, 75247-9141, USA.
T M
TM
Kashner
A
A
Muller
E
E
Richter
A
A
Hendricks
C V
CV
Lukas
D R
DR
Stubblefield
D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000592:standards; D006787:Hospitals, Veterans / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge; D017149:Private Sector / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000145:classification / Q000706:statistics & numerical data*