Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

B. Josea Kramer, PhD¹, Bruce Finke, MD², Debra Saliba, MD, MPH³, Mingming Wang, MPH⁴, Karen R. Josephson, MPH¹, and Judith O. Harker, PhD¹. (1) Geriatric Research Education Clinical Center, VA Greater Los Angeles Healthcare System, UCLA School of Medicine, 16111 Plummer Street (11E), Sepulveda, CA 91343, (2) Indian Health Service Elder Care Initiative, 45 Vernon Street, Northampton, MA 01060, 413-584-0790, bruce.finke@ihs.gov, (3) Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, UCLA School of Medicine, RAND Corporation, 16111 Plummer Street, Sepulveda, CA 91343, (4) Center for the Study of Provider Behavior, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Sepulveda, CA 91343

Background: American Indian and Alaska Native (AIAN) veterans may be eligible for care from both Indian Health Service (IHS) and Veterans Health Administration (VHA). Although the VHA potential role in supplementing limited IHS healthcare is recognized, the extent of dual use is unknown. Objectives: 1) Determine on a national level the extent of dual use of IHS and VHA, 2) describe the characteristics of dual users and 3) identify types of medical and mental health care that are accessed in each system by dual users. Methods: We analyzed centralized administrative data from the VHA's National Patient Data Base and the IHS's National Patient Information Reporting System for FY02- FY03. IHS enrollees' data were linked and merged with VHA data so that our dataset would include only IHS-eligible AIAN who were identified as veterans in either VHA and/or IHS utilization files (n=64,746). Descriptive statistical analyses were used to summarize demographic characteristics and utilization of specific clinics (compared on the basis of function). Results: Dual users comprised 25% of AIAN veteran population. Health records for dual users (n=16,387) included 683,998 outpatient encounters, 3131 short stay hospital discharges and 827 long-stay hospital discharges. Dual users, when compared to IHS-only or VHA-only users, were similar in age (average = 55 years; age ≥ 65 = 25%), more likely to be female (14% v 7% and 8%, respectively) and had more outpatient encounters (mean of 18.9 ± 23.3 v 9.8 ± 11.9 and 16.0 ± 23.6, respectively). Dual users, in comparison to VHA-only users, had similar priority status for VHA care based on the degree and severity of their service-connected injury or illness and in the percent receiving monetary benefits for military service-connected compensation or non-service connected pensions (47%). For dual users, care was not evenly divided between IHS and VHA. Dual users were likely to use IHS for primary care visits (64%) and VHA for specialized medical (79%), mental health (86%), diagnostic (89%) or rehabilitative care (71%). Conclusions: VHA is an important source of healthcare for AIAN veterans and dual use may be related to availability of specialized healthcare services.

Learning Objectives:

• Describe the roles of two federal healthcare providers (the VHA and the IHS) in providing medical and mental health care to a shared target population of American Indian and Alaska Native veterans.

Keywords: Health Care Utilization, Native Americans

Presenting author's disclosure statement:

Any relevant financial relationships? No