Hospital Use and Survival among Veterans Affairs Beneficiaries
Carol M. Ashton, M.D., M.P.H., Julianne Souchek, Ph.D., Nancy J. Petersen, Ph.D., Terri J. Menke, Ph.D., Tracie C. Collins, M.D., M.P.H., Kenneth W. Kizer, M.D., M.P.H., Steven M. Wright, Ph.D., and Nelda P. Wray, M.D., M.P.H.
Background Initiatives to reduce hospital care were part ofthe reorganization of the Department of Veterans Affairs (VA)medical care system undertaken in the mid-1990s. We examinedchanges in the use of VA health services and survival from 1994through 1998 among VA beneficiaries with serious chronic diseases.We postulated that if access to hospital care was reduced toomuch, or if decreased hospital use was not offset by improvementsin ambulatory care, urgent care visits would increase or survivalrates would fall.
Methods We tracked changes in risk-adjusted VA bed-day rates,rates of medical visits, rates of visits for testing and consultation,and rates of urgent care visits per patient-year among VA beneficiariesin nine disease cohorts (a total of 342,300 beneficiaries).Trends in non-VA hospital use by VA beneficiaries 65 years ofage or older who were enrolled in fee-for-service Medicare werealso studied. VA and Medicare vital-status data were used tocalculate one-year survival rates.
Results From 1994 through 1998, VA bed-day rates fell by 50percent, rates of medical-clinic visits and visits for testingand consultation increased moderately, and rates of urgent carevisits fell by 35 percent. The sharp decline in the use of VAhospitals was not compensated for by increases in the use ofMedicare-reimbursed non-VA hospital care by veterans eligiblefor both VA care and Medicare, and the use of non-VA hospitalsactually declined in four cohorts. The survival rates were essentiallyunchanged over the study period.
Conclusions The marked decline in VA hospital use from 1994through 1998 did not curtail access to needed services and wasnot associated with serious consequences for chronically illVA beneficiaries.
Source Information
From the Center for Quality of Care and Utilization Studies, Houston Veterans Affairs Medical Center, and Baylor College of Medicine — all in Houston (C.M.A., J.S., N.J.P., T.J.M., T.C.C., N.P.W.); and the Headquarters of the Veterans Health Administration, Washington, D.C. (K.W.K., S.M.W.).
Address reprint requests to Dr. Ashton at the VA Medical Center (152), 2002 Holcombe Blvd., Houston, TX 77030, or at carol.ashton{at}med.va.gov.
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