Comparisons of Utilization and Costs among Women Veterans Obtaining Primary Care in Community Clinics and Veterans Affairs (VA) Medical Centers
- Presenter:
Chair: F. Reed Johnson; Discussant: TBA Mon June 5, 2006 17:15-18:45 Room 225
Rationale: Women are one of the fastest growing segments of VA users, projected to be 10% of the total population of veteran users by 2010. About 11% of 1.6 million women veterans use the VA for some or all of their health care. The lack of awareness of the historic role women have played in the military and their numerical minority have created ethical and logistical problems in trying to create delivery systems that assure their equitable access to high quality comprehensive health services. The VA health care system has developed a system of community-based outpatient clinics (CBOCs) to complement VA Medical Centers (VAMCs) to optimize veterans’ access to primary care services.
Objectives: This study compares health care costs and utilization for women veterans seeking primary care at VAMCs and CBOCs.
Methods: Utilization and expenditure data were obtained from VA DSS Inpatient and Outpatient National Extracts (2000-01) among CBOCs (n=108; 800 women) and their affiliated VAMCs (n=78; 1,044 women) if in operation in 1999, were serving 200+ veterans, and could be tracked independently in DSS. We estimated utilization using negative binomial models and costs using generalized linear models, controlling for patient characteristics, and adjusting for sampling-weights and intracluster-correlation.
Results: Women using CBOCs were older (53 vs 48), had lower service-related disability (15% vs 21%), and were more likely to be a new patient (23% vs 18%) than women using VAMCs (p<0.0001). CBOC patients were less likely to use outpatient services, including specialty care, laboratory, radiology, and other services than VAMC patients (p<0.0001). There was no significant difference in the number of primary care visits between VAMC and CBOC patients; however, VAMC patients had significantly higher primary care costs than CBOC patients due to higher costs-per-primary care visit ($180 vs $118). CBOC patients had significantly lower total outpatient costs (-832, p<0.0001) and total costs (-$894, p<0.0001) than VAMC patients.
Conclusions: CBOC women receive comparable primary care, but fewer specialty and ancillary services than those at VAMCs. CBOC patients appear to be healthier, while CBOCs also offer fewer required services than their VAMC counterparts. Access to evidence-based clinical services is critical to the health of female veterans. VA care should differ only for patient-related factors, not in facility-specific service availability, provider knowledge or expertise, or logistic challenges for veterans. Given the rapidly expanding female patient population, further research is required to assure that veteran women are offered appropriate access to high quality and gender-sensitive care at both CBOCs and VAMCs.
