title: Factors associated with program utilization of radiation therapy treatment for VHA and medicare dually enrolled patients.
abstract: We examine how distance to a Veterans Health Administration (VHA) facility, patient hometown classification (e.g., small rural town), and service-connected disability are associated with veterans' utilization of radiation therapy services across the VHA and Medicare. In 2008, 45,914 dually-enrolled veteran patients received radiation therapy. Over 3-quarters (35,513) of the patients received radiation therapy from the Medicare program. Younger age, male gender, shorter distance to a VHA facility, and VHA priority or disability status increased the odds of utilizing the VHA. However, veterans residing in urban areas were less likely to utilize the VHA. Urban dwelling patients' utilization of Medicare instead of the VHA suggests a complex decision that incorporates geographic access to VHA services, financial implications of veteran priority status, and the potential availability of multiple sources of radiation therapy in competitive urban markets.
authors.affiliation: Department of General Internal Medicine and Geriatrics, VA Center of Excellence on Implementing Evidence Based Practice, Regenstrief Institute Inc., Indiana University School of Medicine, Indianapolis, IN 46202, USA. Drddfrench@yahoo.com
authors.forename: Dustin D
authors.initials: DD
authors.lastname: French
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Bradham
authors.forename: Robert R
authors.initials: RR
authors.lastname: Campbell
authors.forename: David A
authors.initials: DA
authors.lastname: Haggstrom
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Myers
authors.forename: Neale R
authors.initials: NR
authors.lastname: Chumbler
authors.forename: Michael P
authors.initials: MP
authors.lastname: Hagan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D009784:Occupational Diseases; D060051:Occupational Injuries; D011878:Radiotherapy / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*