Shifting the financial burden: the VA ambulatory care discharge policy.
The Department of Veterans Affairs is a primary source of health care services for many of the nation's uninsured and underinsured. Changes in congressionally mandated eligibility criteria and limited increases in appropriations have forced the Department to adopt a policy of discharging chronic but stable outpatients who have been treated for non-service-connected health conditions. Survey data from one VA medical center suggest that many, but not all, of those discharged: 1) have either Medicare or private insurance coverage; 2) have not sought or found alternative physician services in their local communities; 3) have discontinued taking previously prescribed medications; 4) report worsened health status since discharge; and, 5) have been hospitalized. In general, discharged patients from the lowest income group report the greatest financial access barriers. Preliminary analyses of the discharge policy suggest the potential for decreased access to needed medical services due to financial factors and cost-shifting from the VA to patients and other federal, state and local payers and providers.
Wakefield
D S
DS
College of Medicine and Graduate College, University of Iowa, Iowa City.
Ludke
R L
RL
Rohrer
J E
JE
Booth
B M
BM
Breese
S
S
Moen
A
A
Fortney
J
J
Zeitler
R
R
D002908:Chronic Disease / Q000191:economics; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006302:Health Services Research; D006787:Hospitals, Veterans / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008489:Medical Indigency / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data