Correspondence

Use of Veterans Affairs Medical Care by Enrollees in Medicare HMOs

N Engl J Med 1997; 337:1013-1014October 2, 1997

Article

To the Editor:

Older people in the United States who use the medical services of the Veterans Health Administration are frequently also entitled to health care through Medicare. Although most do not use both these federally funded systems at the same time, substantial use of both the Veterans Health Administration and Medicare fee-for-service care has been documented.1-5 Less is known about the use of Veterans Health Administration services by enrollees in Medicare health maintenance organizations (HMOs). We studied the dual use of these two federal programs with respect to inpatient and outpatient services.

We merged inpatient and outpatient data from the Miami Veterans Affairs Medical Center (VAMC) for 1992 and 1993 with data on Medicare enrollment in Florida in those years, to determine eligibility for Medicare. We obtained information on HMO enrollment, age, and race from the Medicare files of the Health Care Financing Administration. Our analyses were limited to men 65 years of age or older.

Of 5074 inpatient admissions to the Miami VAMC of Medicare beneficiaries over the age of 65, 27.5 percent involved men enrolled in Medicare HMOs (Table 1Table 1Use of the Miami VAMC by Male Medicare Beneficiaries 65 Years of Age or Older, 1992–1993.). The percentage of admissions involving Medicare HMO enrollees was slightly higher in the oldest age group (men over 80); it decreased with increasing income and was substantially higher among blacks. We also studied patterns of admissions according to diagnosis-related groups and found no difference between fee-for-service and HMO enrollees (data not shown).

Of 239,499 outpatient visits to the VAMC by Medicare beneficiaries, 28.0 percent involved enrollees in Medicare HMOs. The proportion of outpatient visits made by HMO enrollees was lowest among men over the age of 80, and (as with inpatient admissions) it decreased with increasing income and was substantially higher among blacks.

Thus, in 1992 and 1993, more than a quarter of the inpatient and outpatient care provided at the Miami VAMC to Medicare beneficiaries was provided to enrollees in Medicare HMOs, and HMO enrollment did not seem to affect the type or the amount of care sought. Prepayment to both systems implies potential duplication, raising important questions about the continuity and cost of care, as well as the judicious allocation of resources.

Carolee A. DeVito, Ph.D., M.P.H.
University of Miami, Miami Beach, FL 33139

Robert O. Morgan, Ph.D.
Miami Veterans Affairs Medical Center, Miami, FL 33125

Beth A. Virnig, Ph.D., M.P.H.
University of Miami, Miami Beach, FL 33139

5 References

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   General Accounting Office. Veterans health care: use of VA services by Medicare eligible veterans. Washington, D.C.: Government Printing Office, October 1994. (GAO/HEHS-95-13.)
   

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   Fisher ES, Welch HG. The future of the Department of Veterans Affairs health care system. JAMA 1995;273:651-655
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   Fisher ES. VA Outcomes Group 1994 report. Unmanaged care: dual utilization of the Veterans Health Administration and Medicare health care systems. White River Junction, Vt.: Veterans Affairs Medical Center, 1994.
   

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   Morgan RO, DeVito C, Simpson L. Co-utilization of VA and Medicare inpatient services. Presented at the Department of Veterans Affairs Annual Health Services Research and Development Service Meeting, Washington, D.C., April 26, 1994.
   

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   Wolinsky FD, Coe RM, Mosely RR II, Homan SM. Veterans' and nonveterans' use of health services: a comparative analysis. Med Care 1985;23:1358-1371
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Citing Articles (7)

Citing Articles

1. 1

   Joseph S. Ross, Salomeh Keyhani, Patricia S. Keenan, Susannah M. Bernheim, Joan D. Penrod, Kenneth S. Boockvar, Harlan M. Krumholz, Albert L. Siu. (2008) Dual Use of Veterans Affairs Services and Use of Recommended Ambulatory Care. Medical Care 46:3, 309-316
   CrossRef

2. 2

   Mary S. Vaughan-Sarrazin, Bonnie Wakefield, Gary E. Rosenthal. (2007) Mortality of Department of Veterans Affairs Patients Undergoing Coronary Revascularization in Private Sector Hospitals. Health Services Research 42:5, 1802-1821
   CrossRef

3. 3

   Margaret M. Byrne, Mark Kuebeler, Kenneth Pietz, Laura A. Petersen. (2006) Effect of Using Information From Only One System for Dually Eligible Health Care Users. Medical Care 44:8, 768-773
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4. 4

   Hester, Eric J., , Cook, Deborah J., , Robbins, Laurence J., . (2005) The VA and Medicare HMOs — Complementary or Redundant?. New England Journal of Medicine 353:12, 1302-1303
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5. 5

   Steven M. Wright, Laura A. Petersen, Rebecca P. Lamkin, Jennifer Daley. (1999) Increasing Use of Medicare Services by Veterans With Acute Myocardial Infarction. Medical Care 37:6, 529-537
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6. 6

   Steven J. Borowsky, Diane C. Cowper. (1999) Dual Use of VA and Non-VA Primary Care. Journal of General Internal Medicine 14:5, 274-280
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7. 7

   Laura A. Petersen, Steven Wright. (1999) Does the VA Provide "Primary" Primary Care?. Journal of General Internal Medicine 14:5, 318-319
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