Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #113731

Robert O. Morgan, PhD¹, Jessica Davila, PhD¹, Margaret Byrne, PhD², Debora A. Paterniti, PhD³, Dolly A. John, MPH⁴, Jennifer Hasche, MSc⁴, and Laura Petersen, MD¹. (1) Houston Center for Quality of Care and Utilization Studies, Houston VA Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd. (152), Houston, TX 77030, (713) 794-8635, rmorgan@bcm.tmc.edu, (2) Department of Epidemiology and Public Health, University of Miami School of Medicine, Highland Professional Building, 1801 NW 9th Avenue, Suite 200, Miami, FL 33136, (3) Center for Health Services Research in Primary Care, Dept. of Int. Med., UC-Davis Medical Center, 4150 V Street, Suite 2500, Sacramento, CA 95817, (4) Houston Center for Quality of Care and Utilization Studies, Veterans Affairs Medical Center, 2002 Holcombe Blvd. (152), Houston, TX 77030

Background. Compared to traditional Medicare, Medicare managed care plans (HMOs) often provide additional services and/or reduced costs. Since many veterans enroll in Medicare HMOs, changes in Medicare HMO policies can have a significant impact on VA system use. This study examines reasons for enrolling in Medicare HMOs and attitudes about the VA system among Medicare-enrolled veterans who do and do not use the VA for care. Methods. We used data from a prospective mailed survey of VA-using and VA non-using (no VA use in prior 3 years), elderly, male veterans in six large metropolitan areas. VA users were sub-classified based on whether they reported receiving most of their medical care from the VA (‘primary' VA users) or from non-VA sources (‘secondary' VA users). Analyses were weighted to reflect the sampling proportions used in each area. The overall survey response rate was 52%. Our final analysis sample included 1,258 VA-users and 828 VA non-users. Results. 31.3% of VA users and 32.9% of VA non-users in our sampling areas were enrolled in Medicare HMOs. Among VA users, 29.3% of HMO enrollees were primary VA users, compared to 38.2% of non-HMO enrollees (p ≤ .0001). Among HMO enrollees, secondary VA users and VA non-users were more likely to cite cost factors (e.g., reducing co-payments), coverage factors (e.g., availability of specialty care), or physician or hospital availability as reasons why they joined their HMO plan (p ≤ .01 for all comparisons). In contrast, primary VA users enrolled in HMOs were more likely to regard the quality of care at the VA as both affordable and better (p ≤ .001 for both). Conclusions. Primary and secondary VA users view Medicare HMOs and the VA system quite differently, with secondary VA users resembling VA non-users in terms of their reasons for joining Medicare HMOs. Reductions in service and/or price increases by Medicare HMOs are likely to mitigate the reasons secondary VA users and VA non-using veterans cite for joining HMOs. In contrast, increases in services, or price reductions by HMOs do not appear as likely to influence primary VA users to seek care outside of the VA. Most HMO enrolled VA users reported using the VA as a secondary source of care. Even in the absence of increased enrollment in the VA system, reductions in service provided by Medicare HMOs, or increases in costs, could put the VA system at substantial risk for increased demand.

Learning Objectives:

• At the conclusion of this session, attendees will be able to discuss how VA users and non-users differ in their views of Medicare managed care and the VA system.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.