Use of Medicare and Department of Veterans Affairs health care by veterans with dementia: a longitudinal analysis.
The objectives of this study were to examine longitudinal patterns of Department of Veterans Affairs (VA)-only use, dual VA and Medicare use, and Medicare-only use by veterans with dementia. Data on VA and Medicare use were obtained from VA administrative datasets and Medicare claims (1998-2001) for 2,137 male veterans who, in 1997, used some VA services, had a formal diagnosis of Alzheimer's disease or vascular dementia in the VA, and were aged 65 and older. Generalized ordered logit models were used to estimate the effects of patient characteristics on use group over time. In 1998, 41.7% of the sample were VA-only users, 55.4% were dual users, and 2.9% were Medicare-only users. By 2001, 30.4% were VA-only users, 51.5% were dual users, and 18.1% were Medicare-only users. Multivariate results show that greater likelihood of Medicare use was associated with older age, being white, being married, having higher education, having private insurance or Medicaid, having low VA priority level, and living in a nursing home or dying during the year. Higher comorbidities were associated with greater likelihood of dual use as opposed to any single system use. Alternatively, number of functional limitations was associated with greater likelihood of Medicare-only use and less likelihood of VA-only use. These results imply that different aspects of veterans' needs have differential effects on where they seek care. Efforts to coordinate care between VA and Medicare providers are necessary to ensure that patients receive high-quality care, especially patients with multiple comorbidities.
Zhu
Carolyn W
CW
Research Enhancement Award Program and Geriatric Research, Health Services Research and Development Service, James J. Peters Veterans Affairs Medical Center, Bronx, New York 10468, USA. carolyn.zhu@mssm.edu
Penrod
Joan D
JD
Ross
Joseph S
JS
Dellenbaugh
Cornelia
C
Sano
Mary
M
D000368:Aged; D003704:Dementia / Q000628:therapy; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs
Soc Sci Med. 2000 Jun;50(12):1743-55
10798329
JAMA. 1963 Sep 21;185:914-9
14044222
J Gen Intern Med. 1999 May;14(5):274-80
10337036
Neuroepidemiology. 2007;29(1-2):125-32
17975326
Med Care Res Rev. 2003 Sep;60(3 Suppl):146S-167S
15095551
J Am Geriatr Soc. 1999 Sep;47(9):1065-71
10484247
J Am Geriatr Soc. 2000 Jun;48(6):639-46
10855599
Med Care. 2007 Mar;45(3):214-23
17304078
J Gerontol B Psychol Sci Soc Sci. 2001 Jul;56(4):S219-28
11445614
Health Serv Res. 1997 Feb;31(6):739-54
9018214
Soc Sci Med. 1994 Jul;39(1):95-104
8066492
Am J Med. 2002 Feb 15;112(3):169-75
11893342
Health Res Policy Syst. 2005 Apr 18;3(1):5
15836789
N Engl J Med. 2003 May 29;348(22):2209-17
12773649
Med Care. 1999 Jun;37(6):529-37
10386565
Milbank Mem Fund Q Health Soc. 1976 Fall;54(4):439-67
137366
Med Care Res Rev. 2003 Jun;60(2):253-67
12800686
J Rural Health. 2005 Spring;21(2):167-71
15859054
J Am Geriatr Soc. 2004 Feb;52(2):187-94
14728626