The use of U.S. Department of Veterans Affairs (VA) services is affected by economic and policy changes outside the VA, such as Medicaid eligibility, private employer insurance coverage, unemployment, and non-VA physician availability, according to a new study led by Boston University School of Public Health (BUSPH) researchers.
The study, published in Health Services Research, found Medicaid expansion following the Affordable Care Act was associated with a 9.1 percent reduction in VA healthcare utilization in the expansion states, amounting to $833 million less in VA spending.
“As most veterans live and work in community settings, the choice to use VA healthcare services is likely influenced by factors both internal and external to the VA,” says lead author Dr. Amresh Hanchate, a health economist at VA Boston Healthcare System, associate professor of medicine at Boston University School of Medicine, and associate professor of health law, policy & management at BUSPH. “Thus, a better understanding of how these factors influence the choice of VA healthcare services is important for VA’s continued ability to meet veterans’ healthcare needs.”
The researchers examined VA healthcare enrollment and utilization from area-level data on Medicaid policy, unemployment, employer-sponsored insurance, housing prices, and non-VA physician availability. Using VA data, they identified more than 8 million veterans, aged 18 and older, who had either received or were enrolled to receive VA health care during 2008-2014.