Dual use of Medicare and the Veterans Health Administration: are there adverse health outcomes?

TitleDual use of Medicare and the Veterans Health Administration: are there adverse health outcomes?
Publication TypeJournal Article
Year of Publication2006
AuthorsWolinsky, FD, Miller, TR, An, H, Brezinski, PR, Vaughn, TE, Rosenthal, GE
JournalBMC Health Serv Res
Date Published2006 Oct 09
ISSN Number1472-6963
KeywordsAged, Aged, 80 and over, Deductibles and Coinsurance, Episode of Care, Health Services Research, Hospitals, Veterans, Humans, Male, Medicare, Mortality, Outcome Assessment, Health Care, Proportional Hazards Models, Quality Indicators, Health Care, Risk Assessment, Selection Bias, Surveys and Questionnaires, United States, United States Department of Veterans Affairs, Veterans

BACKGROUND: Millions of veterans are eligible to use the Veterans Health Administration (VHA) and Medicare because of their military service and age. This article examines whether an indirect measure of dual use based on inpatient services is associated with increased mortality risk.

METHODS: Data on 1,566 self-responding men (weighted N = 1,522) from the Survey of Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to Medicare claims and the National Death Index. Dual use was indirectly indicated when the self-reported number of hospital episodes in the 12 months prior to baseline was greater than that observed in the Medicare claims. The independent association of dual use with mortality was estimated using proportional hazards regression.

RESULTS: 96 (11%) of the veterans were classified as dual users. 766 men (50.3%) had died by December 31, 2002, including 64.9% of the dual users and 49.3% of all others, for an attributable mortality risk of 15.6% (p < .003). Adjusting for demographics, socioeconomics, comorbidity, hospitalization status, and selection bias at baseline, as well as subsequent hospitalization for ambulatory care sensitive conditions, the independent effect of dual use was a 56.1% increased relative risk of mortality (AHR = 1.561; p = .009).

CONCLUSION: An indirect measure of veterans' dual use of the VHA and Medicare systems, based on inpatient services, was associated with an increased risk of death. Further examination of dual use, especially in the outpatient setting, is needed, because dual inpatient and dual outpatient use may be different phenomena.

User Guide Notes


Endnote Keywords

Veterans: statistics/numerical/Medicare/public Policy/Mortality

Endnote ID


Alternate JournalBMC Health Serv Res
Citation Key7116
PubMed ID17029643
PubMed Central IDPMC1617101
Grant ListR01 AG022913 / AG / NIA NIH HHS / United States
R03 AG027741 / AG / NIA NIH HHS / United States