Relationship Between Clinical Conditions and Use of Veterans Affairs Health Care Among Medicare-Enrolled Veterans

Many veterans eligible for health care through Veterans Affairs (VA) and Medicare seek treatment from both; certain factors determine which services they access from each system. Coordinating patient care between systems must be a policy priority.

The Veterans Affairs (VA) Health Care System is large, treating more than 5.4 million patients in fiscal year 2005. But 42 percent of veterans are also Medicare-eligible. This study used VA and Medicare data from fiscal years 2003 and 2004–more than 1.9 million patient records–to examine program usage. The focus was whether patients’ medical conditions explained reliance on the VA versus Medicare, beyond what could be explained by factors such as patient characteristics and access.

Key Findings:

  • Veterans under age 65 were likely to be more reliant on the VA versus Medicare, compared to those over 65.
  • A veteran is given a priority rating by the VA based on income and severity of the service-related disability. Data shows the higher this priority rating, the more reliant on VA services the veteran is likely to be.
  • Most medical conditions were not associated with VA reliance, but patients treated for mental health and substance abuse were significantly more likely to depend on VA care. Patients treated for acute conditions were less likely to go to a VA center, probably because they went to the nearest hospital.
  • Patients under age 65 with eye, ear, nose and throat problems were marginally more VA dependent; younger, blind vets may be accessing the VA’s specialized rehabilitation services.
  • Inpatients were more likely to be hospitalized in a VA facility if they suffered from eye, mental health, infectious or parasitic conditions or amputations.

While some medical conditions do impact where a veteran obtains care, other factors are more fundamental, such as age, distance to a VA facility and the VA priority level. Dual use is common, and data shows them using more services, suggesting they may be more ill. Coordinating care between systems must be a policy priority.