Use of VA and Medicare services by dually eligible veterans with psychiatric problems

被引:43
作者
Carey, Kathleen
Montez-Rath, Maria E.
Rosen, Amy K.
Christiansen, Cindy L.
Loveland, Susan
Ettner, Susan L.
机构
[1] VA Ctr Hlth Qual Outcomes & Econ Res, Bedford, MA 01730 USA
[2] Boston Univ, Sch Publ Hlth, Bedford, MA 01730 USA
[3] Boston Univ, Sch Publ Hlth, Mountain View, CA USA
[4] Univ Calif Los Angeles, Dept Hlth Serv, Los Angeles, CA USA
[5] Univ Calif Los Angeles, Dept Med, Div Gen Internal Med, Los Angeles, CA 90024 USA
[6] Univ Calif Los Angeles, Dept Med, Hlth Serv Res, Los Angeles, CA 90024 USA
关键词
veterans; Medicare; expenditures; mental health and substance abuse;
D O I
10.1111/j.1475-6773.2008.00840.x
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective. To examine how service accessibility measured by geographic distance affects service sector choices for veterans who are dually eligible for veterans affairs (VA) and Medicare services and who are diagnosed with mental health and/or substance abuse (MH/SA) disorders. Data Sources. Primary VA data sources were the Patient Treatment (acute care), Extended Care (long-term care), and Outpatient Clinic files. VA cost data were obtained from (1) inpatient and outpatient cost files developed by the VA Health Economics and Resource Center and (2) outpatient VA Decision Support System files. Medicare data sources were the denominator, Medicare Provider Analysis Review (MEDPAR), Provider-of-Service, Outpatient Standard Analytic and Physician/Supplier Standard Analytic files. Additional sources included the Area Resource File and Census Bureau data. Study Design. We identified dually eligible veterans who had either an inpatient or outpatient MH/SA diagnosis in the VA system during fiscal year (FY)'99. We then estimated one- and two-part regression models to explain the effects of geographic distance on both VA and Medicare total and MH/SA costs. Principal Findings. Results provide evidence for substitution between the VA and Medicare, demonstrating that poorer geographic access to VA inpatient and outpatient clinics decreased VA expenditures but increased Medicare expenditures, while poorer access to Medicare-certified general and psychiatric hospitals decreased Medicare expenditures but increased VA expenditures. Conclusions. As geographic distance to VA medical facility increases, Medicare plays an increasingly important role in providing mental health services to veterans.
引用
收藏
页码:1164 / 1183
页数:20
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