Costs Associated with Health Care Services Accessed through VA and in the Community through Medicare for Veterans Experiencing Homelessness
Corresponding Author
Richard E. Nelson Ph.D.
VA Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Address correspondence to Richard E. Nelson Ph.D., VA Salt Lake City Health Care System, 500 Foothill Blvd, Salt Lake City, UT 84148; and also Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT; e-mail: [email protected].Search for more papers by this authorYing Suo M.Stat.
VA Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorWarren Pettey M.P.H., C.P.H.
VA Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorMegan Vanneman Ph.D., M.P.H.
VA Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorAnn Elizabeth Montgomery Ph.D.
National Center on Homelessness Among Veterans, Philadelphia, PA
School of Public Health, University of Alabama at Birmingham, Birmingham, AL
Search for more papers by this authorThomas Byrne Ph.D.
National Center on Homelessness Among Veterans, Philadelphia, PA
School of Social Work, Boston University, Boston, MA
Search for more papers by this authorJamison D. Fargo Ph.D.
VA Salt Lake City Health Care System, Salt Lake City, UT
National Center on Homelessness Among Veterans, Philadelphia, PA
Department of Psychology, Utah State University, Logan, UT
Search for more papers by this authorAdi V. Gundlapalli M.D., Ph.D.
VA Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
National Center on Homelessness Among Veterans, Philadelphia, PA
Search for more papers by this authorCorresponding Author
Richard E. Nelson Ph.D.
VA Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Address correspondence to Richard E. Nelson Ph.D., VA Salt Lake City Health Care System, 500 Foothill Blvd, Salt Lake City, UT 84148; and also Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT; e-mail: [email protected].Search for more papers by this authorYing Suo M.Stat.
VA Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorWarren Pettey M.P.H., C.P.H.
VA Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorMegan Vanneman Ph.D., M.P.H.
VA Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorAnn Elizabeth Montgomery Ph.D.
National Center on Homelessness Among Veterans, Philadelphia, PA
School of Public Health, University of Alabama at Birmingham, Birmingham, AL
Search for more papers by this authorThomas Byrne Ph.D.
National Center on Homelessness Among Veterans, Philadelphia, PA
School of Social Work, Boston University, Boston, MA
Search for more papers by this authorJamison D. Fargo Ph.D.
VA Salt Lake City Health Care System, Salt Lake City, UT
National Center on Homelessness Among Veterans, Philadelphia, PA
Department of Psychology, Utah State University, Logan, UT
Search for more papers by this authorAdi V. Gundlapalli M.D., Ph.D.
VA Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
National Center on Homelessness Among Veterans, Philadelphia, PA
Search for more papers by this authorAbstract
Objective
To estimate health care utilization and costs incurred by homeless Veterans relative to nonhomeless Veterans and to examine the impact of a VA homelessness program on these outcomes.
Data Sources/Study Setting
Combined Department of Veterans Affairs (VA) administrative and Medicare claims data.
Study Design
Observational study using longitudinal data from Veterans engaged with the VA system and enrolled in Medicare. Veterans with administrative evidence of homelessness at any point during 2006–2010 were matched on period of military service to Veterans with no evidence of homelessness.
Principal Findings
Experience of homelessness was associated with 1.37 (95 percent CI = 1.34–1.40) and 0.16 (95 percent CI = 0.14–0.17) more outpatient encounters per quarter in VA and non-VA settings, respectively, and 1.31 (95 percent CI = 1.30–1.32) and 0.49 (95 percent CI = 0.48–0.49) more inpatient days per quarter in VA and non-VA hospitals, respectively. These were associated with higher costs. Relative to stably housed Veterans less than 65 years of age, those enrolled in a VA homelessness program had 94.4 percent (95 percent CI = 90.7 percent–98.1 percent) more VA outpatient visits but 5.5 percent (95 percent CI = 3.0 percent–7.9 percent) fewer Medicare outpatient visits.
Conclusions
Homelessness was associated with an increase in VA and Medicare utilization and cost. A VA homelessness program decreased use of Medicare outpatient services.
Supporting Information
| Filename | Description |
|---|---|
| hesr13054-sup-0001-AppendixA1.pdfPDF document, 1.5 MB | Appendix SA1: Author Matrix. |
| hesr13054-sup-0002-Supinfo1.docxWord document, 90.1 KB |
Figure S1: Cohort Creation Diagram. Table S1: Patient Characteristics. |
| hesr13054-sup-0003-TableS2.docxWord document, 23.9 KB | Table S2: Regression Results – Impact of Homelessness on VA and Medicare Utilization – by HUD-VASH. |
| hesr13054-sup-0004-Supinfo2.docxWord document, 104 KB |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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