title: Veterans' access to and use of Medicare and Veterans Affairs health care.
abstract: OBJECTIVE
  We examined the impact of access to care characteristics on health care use patterns among those veterans dually eligible for Medicare and Veterans Affairs (VA) services.
  
  
  METHODS
  We used a retrospective, cross-sectional design to identify veterans who were eligible to use VA and Medicare health care in calendar year 1999. We analyzed national VA utilization and Medicare claims data. We used descriptive and multivariable generalized ordered logit analyses to examine how patient, geographic, and environmental factors affect the percent reliance on VA and Medicare inpatient and outpatient services.
  
  
  RESULTS
  Of the 1.47 million veterans in our study population with outpatient use, 18% were VA-only users, 36% were Medicare-only users, and 46% were both VA and Medicare users. Among veterans with inpatient use, 24% were VA only, 69% were Medicare only, and 6% were both VA and Medicare users. Multivariable analysis revealed that veterans who were black or had a higher VA priority were most likely to rely on the VA. Patient with higher risk scores were most likely to rely on a combination of VA and Medicare health care. Patients who lived farther from VA hospitals were less likely to rely on VA health care, particularly for inpatient care. Patients living in urban areas with more health care resources were less likely to rely on VA health care.
  
  
  CONCLUSIONS
  VA health care provides an important safety net for vulnerable populations. Targeted approaches that carefully consider the simultaneous impacts of VA and Medicare policy changes on minority and high-risk populations are essential to ensure veterans have access to needed health care.
authors.affiliation: VA Information Resource Center (VIReC), Hines, Illinois 60141, USA. denise.hynes@va.gov
authors.forename: Denise M
authors.initials: DM
authors.lastname: Hynes
authors.forename: Kristin
authors.initials: K
authors.lastname: Koelling
authors.forename: Kevin
authors.initials: K
authors.lastname: Stroupe
authors.forename: Noreen
authors.initials: N
authors.lastname: Arnold
authors.forename: Katherine
authors.initials: K
authors.lastname: Mallin
authors.forename: Min-Woong
authors.initials: MW
authors.lastname: Sohn
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
authors.forename: Larry
authors.initials: L
authors.lastname: Manheim
authors.forename: Linda
authors.initials: L
authors.lastname: Kok
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000458:organization & administration*; D011203:Poverty; D044469:Racial Groups; D012189:Retrospective Studies; D012306:Risk; D012424:Rural Population; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D014505:Urban Population; D014728:Veterans