title: Gender and use of care: planning for tomorrow's Veterans Health Administration.
abstract: BACKGROUND
  Historically, men have been the predominant users of Veterans Health Administration (VHA) care. With more women entering the system, a systematic assessment of their healthcare use and costs of care is needed. We examined how utilization and costs of VHA care differ in women veterans compared with men veterans.
  
  
  METHODS
  In this cross-sectional study using centralized VHA administrative databases, main analyses examined annual outpatient and inpatient utilization and costs of care (outpatient, inpatient, and pharmacy) for all female (n = 178,849) and male (n = 3,943,532) veterans using VHA in 2002, accounting for age and medical/mental health conditions.
  
  
  RESULTS
  Women had 11.8% more outpatient encounters, 25.9% fewer inpatient days, and 11.4% lower total cost than men; after adjusting for age and medical comorbidity, differences were less pronounced (1.3%, 10.9%, and 2.8%, respectively). Among the 30.8% of women and 24.4% of men with both medical and mental health conditions, women used outpatient services more heavily than men (31.0 vs. 27.3 annual encounters).
  
  
  CONCLUSIONS
  VHA's efforts to build capacity for women veterans must account for their relatively high utilization of outpatient services, which is especially prominent in women who have both medical and mental health conditions. Meeting their needs may require delivery systems integrating medical and mental healthcare.
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA. sfrayne@stanford.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Frayne
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Ananth
authors.forename: Samina
authors.initials: S
authors.lastname: Iqbal
authors.forename: Ann
authors.initials: A
authors.lastname: Thrailkill
authors.forename: Ciaran S
authors.initials: CS
authors.lastname: Phibbs
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006787:Hospitals, Veterans / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014600:Utilization Review / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*; D016387:Women's Health