title: Medicare and Medicaid enrollment and outside hospitalizations among HIV-infected and uninfected veterans engaged in VA care: a retrospective cohort study.
abstract: BACKGROUND
  Many veterans engaged in care with the Veterans Administration (VA) health system are also enrolled in Medicare and/or Medicaid and may receive care both inside and outside of the VA. Use of dual health systems has been associated with worse outcomes. Veterans with HIV may have different rates of Medicare and Medicaid enrollment and may be at greater risk of poor outcomes related to non-VA use. This study compares the frequency and factors associated with Medicare and/or Medicaid enrollment and non-VA use in an HIV-infected and uninfected population of veterans.
  
  
  METHODS
  We used data from the VA and Center for Medicare & Medicaid Services from 2004 and 2005 to determine the frequency of Medicare and/or Medicaid enrollment among a cohort of HIV-infected and uninfected veterans engaged in VA care. We then restricted the cohort to veterans enrolled in fee-for-service (FFS) Medicare and/or Medicaid with at least one hospitalization and identified characteristics associated with non-VA hospital admissions.
  
  
  RESULTS
  HIV-infected veterans had higher rates of Medicare and/or Medicaid enrollment than uninfected veterans (38% vs. 33%, p < 0.01), though the opposite was true when our sample was limited to veterans 65 years and older (53% vs. 70%, p < 0.0 1). Among veterans enrolled in the VA and FFS Medicare and/or Medicaid, veterans with HIV had greater illness severity and more frequent hospitalizations, but were less likely to be hospitalized outside the VA (48% vs. 54%, p < 0.01). HIV infection was associated with lower odds of outside hospitalization (OR = 0.76 [95% CI: 0.68, 0.85]).
  
  
  CONCLUSIONS
  Veterans with HIV have higher rates of Medicare and/or Medicaid enrollment, but lower odds of non-VA hospitalization. The VA integrated model of HIV care may discourage outside use among HIV-infected veterans.
authors.affiliation: Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT, 06510, USA. Harry.Chang@yale.edu.|Veterans Aging Cohort Study, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA. Harry.Chang@yale.edu.
authors.forename: Harry
authors.initials: H
authors.lastname: Chang
authors.affiliation: Veterans Aging Cohort Study, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA. Janet.Tate2@va.gov.
authors.forename: Janet
authors.initials: J
authors.lastname: Tate
authors.affiliation: Veterans Aging Cohort Study, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA. Amy.Justice2@va.gov.|Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, CT, 06520, USA. Amy.Justice2@va.gov.|Department of Public Health, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA. Amy.Justice2@va.gov.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.affiliation: VA Office of Rural Health (ORH), Midwest Rural Health Resource Center, Iowa City VAMC, 601 Highway 6 West (152), Iowa City, IA, 52246, USA. Michael.Ohl@va.gov.|Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Medical Center, Mailstop 152, Iowa City VAMC, Iowa City, IA, 52246, USA. Michael.Ohl@va.gov.|Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA. Michael.Ohl@va.gov.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Ohl
mesh_terms: D000368:Aged; D018588:Fee-for-Service Plans / Q000191:economics; D015658:HIV Infections / Q000191:economics; D006679:HIV Seropositivity; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D014728:Veterans