Rachael N Martinez1, Bridget M Smith1,2, Dustin D French1,3,4, Timothy P Hogan5,6, Beverly Gonzalez1, Chad M Osteen1, Maya Hatch7,8, Vicki Anderson9, Elizabeth Tarlov1,10, Abigail Silva1,11, Barry Goldstein12,13, Kevin T Stroupe1,11. 1. Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, Hines, Illinois, USA. 2. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 3. Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 4. Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 5. Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA. 6. Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 7. Spinal Cord Injury/Disorders Center at Long Beach, Tibor Rubin Long Beach VAMC, Long Beach, California, USA. 8. Physical Medicine & Rehabilitation Department, University of California Irvine School of Medicine, Orange, California, USA. 9. Spinal Cord Injury/Disorders Center at Edward Hines, Jr. VA Hospital, Hines, Illinois, USA. 10. College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA. 11. Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA. 12. Spinal Cord Injuries and Disorders System of Care National Program Office, Veterans Health Administration, U.S. Department of Veterans Affairs, Seattle, Washington, USA. 13. Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
Abstract
Context/Objective: Provisions of the Affordable Care Act (ACA) potentially increase insurance options for Veterans with disabilities. We examined Veterans with spinal cord injuries and disorders (SCI/D) to assess whether the ACA was associated with changes in healthcare utilization from Department of Veterans Affairs (VA) healthcare facilities.Design: Using national VA data, we investigated impacts on VA healthcare utilization pre- (2012/13) and post-ACA (2014/15) implementation with negative binomial regression models.Setting: VA healthcare facilities.Participants: 8,591 VA users with SCI/D. Veterans with acute myelitis, Guillain-Barré syndrome, multiple sclerosis, or amyotrophic lateral sclerosis were excluded as were patients who died during the study period.Interventions: We assessed VA healthcare utilization before and after ACA implementation.Outcome Measures: Total numbers of VA visits for SCI/D care, diagnostic care, primary care, specialty care, and mental health care, and VA admissions. Results: The number of VA admissions was 7% higher in the post than pre-ACA implementation period (P < 0.01). The number of VA visits post-implementation increased for SCI/D care (8%; P < 0.01) and specialty care (12%; P < 0.001). Conversely, the number of mental health visits was 17% lower in the post-ACA period (P < 0.001). Veterans with SCI/D who live <5 miles from their nearest VA facility received VA care more frequently than those ≥40 miles from VA (P < 0.001). Conclusion: Counter to expectations, results suggest that Veterans with SCI/D sought more frequent VA care after ACA implementation, indicating Veterans with SCI/D continue to utilize the lifelong, comprehensive care provided at VA.
Context/Objective: Provisions of the Affordable Care Act (ACA) potentially increase insurance options for Veterans with disabilities. We examined Veterans with spinal cord injuries and disorders (SCI/D) to assess whether the ACA was associated with changes in healthcare utilization from Department of Veterans Affairs (VA) healthcare facilities.Design: Using national VA data, we investigated impacts on VA healthcare utilization pre- (2012/13) and post-ACA (2014/15) implementation with negative binomial regression models.Setting: VA healthcare facilities.Participants: 8,591 VA users with SCI/D. Veterans with acute myelitis, Guillain-Barré syndrome, multiple sclerosis, or amyotrophic lateral sclerosis were excluded as were patients who died during the study period.Interventions: We assessed VA healthcare utilization before and after ACA implementation.Outcome Measures: Total numbers of VA visits for SCI/D care, diagnostic care, primary care, specialty care, and mental health care, and VA admissions. Results: The number of VA admissions was 7% higher in the post than pre-ACA implementation period (P < 0.01). The number of VA visits post-implementation increased for SCI/D care (8%; P < 0.01) and specialty care (12%; P < 0.001). Conversely, the number of mental health visits was 17% lower in the post-ACA period (P < 0.001). Veterans with SCI/D who live <5 miles from their nearest VA facility received VA care more frequently than those ≥40 miles from VA (P < 0.001). Conclusion: Counter to expectations, results suggest that Veterans with SCI/D sought more frequent VA care after ACA implementation, indicating Veterans with SCI/D continue to utilize the lifelong, comprehensive care provided at VA.
Entities:
Keywords:
Affordable Care Act; Health policy; Insurance; Spinal cord injuries and disorders (SCI/D); Veterans Affairs
Authors: Rachael N Martinez; Elisa J Gordon; Sean Tully; Abigail Silva; Elizabeth Tarlov; Dustin D French; Zhiping Huo; Bridget M Smith; Howard S Gordon; Kevin T Stroupe Journal: Mil Med Date: 2017-05 Impact factor: 1.437
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Authors: Dustin D French; Douglas D Bradham; Robert R Campbell; David A Haggstrom; Laura J Myers; Neale R Chumbler; Michael P Hagan Journal: J Community Health Date: 2012-08
Authors: D M Dryden; L D Saunders; B H Rowe; L A May; N Yiannakoulias; L W Svenson; D P Schopflocher; D C Voaklander Journal: Spinal Cord Date: 2004-09 Impact factor: 2.772
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