title: Health service use and outcome: comparison of low charge, integrated, comprehensive services with usual health care.
abstract: We examined the effects of use of low charge, integrated and comprehensive health care services (Veterans Administration (VA) health care system) on health care service use and health-related outcomes. Data came from the 10-year (1986/87-1996/97) Duke Established Populations for Epidemiologic Studies of the Elderly, with 159 men aged 65-85 who primarily used VA health services compared with 1,100 men aged 65-85 who did not. In controlled analyses, no differences were found between the two groups on number of OTC medications used, or in speed or likelihood of entering a nursing home. However, veterans who primarily used the VA health care system reported more outpatient visits and prescription drugs, and increased likelihood of using an adjunct health care provider; entry into a hospital was quicker, and number of hospitalizations was greater. Although health status was controlled, because of eligibility requirements it remains possible that veterans were sicker. Nevertheless, no differences were found in health outcome (functional status or mortality). Readier access to better integrated health services appears to result in increased use of health services controlled by the health care provider, but not of services requiring the recipient's relocation, while functional status and mortality attained equivalence.
authors: Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA. ggf@geri.duke.edu
authors: Gerda G
authors: GG
authors: Fillenbaum
authors: Bruce M
authors: BM
authors: Burchett
authors: J D
authors: JD
authors: Dan
authors: G
authors: G
authors: Blazer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003191:Comprehensive Health Care / Q000191:economics / Q000706:statistics & numerical data*; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000706:statistics & numerical data*; D003710:Demography; D017048:Health Care Costs; D006296:Health Services / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D009026:Mortality; D017063:Outcome Assessment, Health Care; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*