Veteran Status, Health Status, and Use of Health Services

There are more than seven million veterans aged 70 and older in the United States. Prior research indicates differences in health status and health resource utilization of older veterans, compared with nonveterans of the same age cohort. Improved understanding of these differences can inform fiscal and social policy. One important contributing factor to these differences is the impact of the G.I. Bill. Education is strongly associated with improved health status. Results have implications for health care and education policy, as well as for retirement benefits. This longitudinal research evaluates hypotheses regarding veterans' health status, physician use, and hospital use compared to nonveterans. Education is expected to mediate the veteran effects. The study draws on the Andersen Behavioral Model (1995) for its conceptual framework and is among the most comprehensive applications of the predisposing, enabling, and need paradigm to date. Six waves (1993-2004) of the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD) are analyzed. Primary analyses were conducted using a dichotomous veteran variable (veteran/nonveteran). Separate veteran subgroup analyses (early/late entry, disabled/not disabled, career/noncareer) were also conducted. The study finds evidence of a positive effect of veteran status on both health status and physician utilization, but not hospital utilization. Compared to nonveterans, early entry veterans, non-career veterans and non-disabled veterans have higher health status. Late entry veterans, non-career veterans, and disabled veterans use more physician services relative to nonveterans. The study finds a strong positive effect of education on both health status and physician utilization. Education mediates the veteran status effect on health status and has a direct effect on physician utilization for both veterans and nonveterans. Veteran status also has effects on physician utilization that can not be attributed to education. Further research is warranted to discover specific effects among other veteran cohorts that could be applied to reshape the Veterans' Health Administration and the Military Health delivery systems, as well as to Medicare benefits.

Health Care Utilization

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