Local Area Unemployment and the Demand for Inpatient Care Among Veterans Affairs Enrollees.
Prior research examining the relationship between economic conditions and health service demand has focused primarily on outpatient use. This study examines whether local area unemployment, as an indicator of economic conditions, was associated with use of inpatient care, which is theoretically less subject to discretionary use. Using a random sample of 131,603 patients dually enrolled in the Veterans Affairs (VA) Health System and fee-for-service Medicare, we measured VA, Medicare, and total (VA and Medicare) hospitalizations. Overall, local unemployment was not associated with VA, Medicare, or total hospitalization probability. Among low-income veterans exempt from VA copayments, higher local unemployment was moderately associated with a lower probability of hospitalization through Medicare. For veterans subject to VA copayments, higher local unemployment was moderately associated with a higher likelihood of VA hospitalization. These results suggest inpatient use is less sensitive to the economy, although worse economic conditions slightly affected inpatient demand for select veterans.
Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA University of Washington, Seattle, WA, USA eswong@uw.edu.
Edwin S
ES
Wong
Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA University of Washington, Seattle, WA, USA.
Paul L
PL
Hebert
Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA University of Washington, Seattle, WA, USA.
Karin M
KM
Nelson
University of Washington, Seattle, WA, USA.
Susan E
SE
Hernandez
Veterans Health Administration, Seattle, WA, USA.
Philip W
PW
Sylling
Veterans Health Administration, Seattle, WA, USA.
Stephan D
SD
Fihn
Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA University of Washington, Seattle, WA, USA.
Chuan-Fen
CF
Liu
D000368:Aged; D005260:Female; D006301:Health Services Needs and Demand; D006787:Hospitals, Veterans / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D014478:Unemployment / Q000706:statistics & numerical data*; D014481:United States; D014728:Veterans
Department of Veterans Affairs; enabling resources; hospitalization; unemployment rate