title: Veteran Use of Health Care Systems in Rural States: Comparing VA and Non-VA Health Care Use Among Privately Insured Veterans Under Age 65.
abstract: To quantify use of VA and non-VA care among working-age veterans with private insurance by linking VA data to private health insurance plan (PHIP) data.
  
  
  
  Demographics and utilization were compared between dual users of VA and non-VA systems versus single-system users for veterans < 65 living in 2 rural Midwestern states concurrently enrolled in VA health care and a PHIP for ≥ 1 complete federal fiscal year from 2000 to 2010. Chi-square and t-tests were used for univariate analyses. VA reliance was computed as the percentage of visits, admissions and prescriptions in VA. Multinomial logistic regression was used to compare characteristics by dual use versus non-VA only or VA only use.
  
  
  
  Of 16,330 eligible veterans, 54% used both VA and non-VA services, 39% used non-VA only, and 5% used VA only. Compared with single-system use, dual use was associated with older age, priority levels 1-4, service-connected conditions, rural residence, greater years of study eligibility, and enrollment in the PHIP before VA. VA reliance was 33% for outpatient care, 14% for inpatient, and 40% for pharmacy. PHIP data substantially underestimated VA use compared to VA data; 26% who used VA health care had no VA claims in the PHIP dataset.
  
  
  
  Over half of working-age veterans enrolled in VA and private insurance used services in both systems. Care coordination efforts across systems should include veterans of all ages, particularly rural veterans more likely to be dual users, and better methods are needed to identify veterans with private insurance and their private providers.
authors: Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa. mary-charlton@uiowa.edu.
authors: Mary E
authors: ME
authors: Charlton
authors: VA Office of Rural Health, Rural Health Resource Center-Central Region, and the Comprehensive Access and Delivery Research and Evaluation (CADRE), Center at the Iowa City VA Healthcare System, Iowa City, Iowa.
authors: Michelle A
authors: MA
authors: Mengeling
authors: Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.
authors: Jennifer A
authors: JA
authors: Schlichting
authors: VA Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, Providence VA Healthcare System, Providence, Rhode Island.
authors: Lan
authors: L
authors: Jiang
authors: Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.|VA Office of Rural Health, Rural Health Resource Center-Central Region, and the Comprehensive Access and Delivery Research and Evaluation (CADRE), Center at the Iowa City VA Healthcare System, Iowa City, Iowa.|Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa.
authors: Carolyn
authors: C
authors: Turvey
authors: VA Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, Providence VA Healthcare System, Providence, Rhode Island.|Department of Health Services, Policy and Practice and Department of Medicine, Brown University, Providence, Rhode Island.
authors: Amal N
authors: AN
authors: Trivedi
authors: UC Davis School of Medicine, and Betty Irene Moore School of Nursing, Institute for Population Health Improvement, University of California (UC)-Davis Health System, Sacramento, California.
authors: Kenneth W
authors: KW
authors: Kizer
authors: Research Service, VA Medical Center, White River Junction, Vermont.|Office of Rural Health, Veterans Health Administration, Washington, DC.
authors: Alan N
authors: AN
authors: West
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003695:Delivery of Health Care / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*
keywords: VA health care; care coordination; dual use; rural; veterans