title: Gender disparities in Veterans Health Administration care: importance of accounting for veteran status.
abstract: BACKGROUND
  In an effort to assess and reduce gender-related quality gaps, the Veterans Health Administration (VHA) has promoted gender-based research. Historically, such appraisals have often relied on secondary databases, with little attention to methodological implications of the fact that VHA provides care to some nonveteran patients.
  
  
  OBJECTIVE
  To determine whether conclusions about gender differences in utilization and cost of VHA care change after accounting for veteran status.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  All users of VHA in 2002 (N = 4,429,414).
  
  
  METHODS
  Veteran status, outpatient/inpatient utilization and cost, from centralized 2002 administrative files.
  
  
  RESULTS
  Nonveterans accounted for 50.7% of women (the majority employees) but only 3.0% of men. Among all users, outpatient and inpatient utilization and cost were far lower in women than in men, but in the veteran subgroup these differences decreased substantially or, in the case of use and cost of outpatient care, reversed. Utilization and cost were very low among women employees; women spouses of fully disabled veterans had utilization and costs similar to those of women veterans.
  
  
  CONCLUSIONS
  By gender, nonveterans represent a higher proportion of women than of men in VHA, and some large nonveteran groups have low utilization and costs; therefore, conclusions about gender disparities change substantially when veteran status is taken into account. Researchers seeking to characterize gender disparities in VHA care should address this methodological issue, to minimize risk of underestimating health care needs of women veterans and other women eligible for primary care services.
authors.affiliation: Center for Health Care Evaluation, 795 Willow Road (152-MPD), Menlo Park CA 94025, USA. sfrayne@stanford.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Frayne
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Vu Q
authors.initials: VQ
authors.lastname: Nguyen
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Ananth
authors.forename: Victor Y
authors.initials: VY
authors.lastname: Chiu
authors.forename: Ciaran S
authors.initials: CS
authors.lastname: Phibbs
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D012737:Sex Factors; D018454:Spouses; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*