title: Did Massachusetts Health Reform Affect Veterans Affairs Primary Care Use?
abstract: Massachusetts Health Reform (MHR), implemented in 2006, introduced new health insurance options that may have prompted some veterans already enrolled in the Veterans Affairs Healthcare System (VA) to reduce their reliance on VA health services. This study examined whether MHR was associated with changes in VA primary care (PC) use. Using VA administrative data, we identified 147,836 veterans residing in Massachusetts and neighboring New England (NE) states from October 2004 to September 2008. We applied difference-in-difference methods to compare pre-post changes in PC use among Massachusetts and other NE veterans. Among veterans not enrolled in Medicare, VA PC use was not significantly different following MHR for Massachusetts veterans relative to other NE veterans. Among VA-Medicare dual enrollees, MHR was associated with an increase of 24.5 PC visits per 1,000 veterans per quarter ( p = .048). Despite new non-VA health options through MHR, VA enrollees continued to rely on VA PC.
authors.affiliation: 1 VA Puget Sound Health Care System, Seattle, WA, USA.|2 University of Washington, Seattle, WA, USA.
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Wong
authors.affiliation: 3 Durham VA Medical Center, Durham, NC, USA.|4 Duke University, Durham, NC, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
authors.affiliation: 1 VA Puget Sound Health Care System, Seattle, WA, USA.|2 University of Washington, Seattle, WA, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hebert
authors.affiliation: 1 VA Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Batten
authors.affiliation: 1 VA Puget Sound Health Care System, Seattle, WA, USA.|2 University of Washington, Seattle, WA, USA.
authors.forename: Karin M
authors.initials: KM
authors.lastname: Nelson
authors.affiliation: 5 Veterans Health Administration, Seattle, WA, USA.
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
authors.affiliation: 1 VA Puget Sound Health Care System, Seattle, WA, USA.|2 University of Washington, Seattle, WA, USA.
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
mesh_terms: D005260:Female; D018166:Health Care Reform; D006787:Hospitals, Veterans; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009511:New England; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D014728:Veterans / Q000706:statistics & numerical data
keywords: Veterans Affairs; health care reform; primary care; utilization