title: Unintended consequences of regionalizing specialized VA addiction services.
abstract: OBJECTIVE
  From 1995 to 2000 the Department of Veterans Affairs (VA) dramatically reduced addiction treatment funding and regionalized specialized services to urban centers. By using New York State as an example, this study examined whether regionalization disproportionately affected rural versus urban veterans' use of VA and non-VA inpatient addiction services.
  
  
  METHODS
  By using a comprehensive data set of VA and non-VA hospitalizations for 294,748 VA enrollees who were residents of New York State from 1998 to 2000, this study examined admission rates for addiction treatment to VA and non-VA centers to determine how rates differed between rural veterans and urban veterans.
  
  
  RESULTS
  Between 1998 and 2000 rural veterans obtained 67% of their inpatient addiction care from the VA, compared with 54% for urban veterans (p<.001). Compared with 1998 levels, the odds ratios of admission to VA facilities for inpatient detoxification fell for both rural and urban veterans to .80 in 1999 and .65 in 2000 (both p<.05). Although odds ratios of non-VA inpatient admission for addiction treatment were stable over time for urban veterans, those for rural veterans fell from 1998 values, falling to .76 in 1999 (not significant) and .62 in 2000 (p<.001) for detoxification and to .66 in 1999 (not significant) and .51 in 2000 for rehabilitation (p<.05). Odds ratios for urban veterans' admission to VA facilities for rehabilitation fell to .51 in terms of 1998 rates in 1999 and .38 in 2000, but rural veterans' odds ratios fell more, to .31 and .16, respectively (p<.001 for all).
  
  
  CONCLUSIONS
  In New York regionalization of VA addiction services disproportionately affected rural veterans. Rural veterans experienced concurrent reductions in VA and non-VA inpatient addiction services. The VA and other health care policy makers should consider the potential unintended consequences to rural populations of resource reallocation.
authors.affiliation: Administration Medical Center, Department of Veterans Affairs (VA) Outcomes Group Research Enhancement Awards Program, 215 North Hartland Rd., White River Junction, VT 05009, USA. amy.e.wallace@dartmouth.edu
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wallace
authors.forename: Alan N
authors.initials: AN
authors.lastname: West
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Booth
authors.forename: William B
authors.initials: WB
authors.lastname: Weeks
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D016017:Odds Ratio; D010343:Patient Admission / Q000639:trends; D012040:Regional Health Planning; D012189:Retrospective Studies; D012424:Rural Population; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D014505:Urban Population