Abstract
Research Objective
We examined rates of specific health conditions among female veteran patients and
how the share of health care costs attributable to these conditions changed in the
Veterans Affairs system between 2000 and 2008.
Methods
Veterans’ Administration (VA)-provided and VA-sponsored inpatient, outpatient, and
pharmacy utilization and cost files were analyzed for women veterans receiving care
in 2000 and 2008. We estimated rates of 42 common health conditions and per-patient
condition costs from a regression model and calculated the total population costs
attributable to each condition and changes by year.
Results
The number of female VA patients increased from 156,305 in 2000 to 266,978 in 2008;
88% were under 65 years of age. The rate of women treated for specific conditions
increased substantially for many gender-specific and psychiatric conditions: For example,
pregnancy increased 133%, diagnosed posttraumatic stress disorder increased 106%,
and diagnosed depression increased 41%. Mean costs of care increased from $4,962 per
woman in 2000 to $6,570 per woman in 2008. Psychiatric conditions accounted for more
than one quarter of population health care costs in 2008. Gender-specific conditions
and musculoskeletal diseases accounted for a rising share of population costs and
rose to 8.2% and 8.7% of population costs in 2008, respectively.
Conclusion
Gender-specific, cancer, musculoskeletal, and mental health and substance use disorders
accounted for a greater share of overall costs during the study period and were primarily
driven by higher rates of diagnosed conditions and, for several conditions, higher
treatment costs.
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References
- Effects of the wars on smoking among veterans.Journal of General Internal Medicine. 2010; 25: 102-103
- Systematic review of women veterans health research 2004–2008.Washington, DC: Veterans Health Administration. 2010; (VA-ESP Project #05–226)
- Identifying hypertension-related comorbidities from administrative data: what's the optimal approach?.American Journal of Medical Quality. 2004; 19: 201-206
- Smoking prevalence among US veterans.Journal of General Internal Medicine. 2010; 25: 147-149
- Annual smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000–2004.Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD2008
- Regression, prediction and shrinkage.Journal of the Royal Statistical Society Series B (Methodological). 1983; 45: 311-354
- Prevalence of chronic kidney disease in the United States.JAMA: The Journal of the American Medical Association. 2007; 298: 2038-2047
- Use of medical care for chronic conditions.Health Affairs (Millwood). 2009; 28: 26-35
Department of Veterans Affairs. (2010). VHA handbook 1330.01. Retrieved from http://www.va.gov/vhapublications/.
- Mental disorders and access to medical care in the United States.American Journal of Psychiatry. 1998; 155: 1775-1777
- Medical care needs of returning veterans with PTSD: Their other burden.Journal of General Internal Medicine. 2011; 26: 33-39
- Health status among 28,000 women Veterans. The VA Women's Health Program Evaluation Project.Journal of General Internal Medicine. 2006; 21: S40-S46
- Gender disparities in Veterans Health Administration care: Importance of accounting for veteran status.Medical Care. 2008; 46: 549-553
- Gender and use of care: Planning for tomorrow's Veterans Health Administration.Journal of Womens Health (Larchmt). 2007; 16: 1188-1199
- New women veterans in the VHA: A longitudinal profile.Women's Health Issues. 2011; 21: S103-S111
- Evidence-based national initiatives to address tobacco use as a public health priority in the Veterans Health Administration.Military Medicine. 2009; 174: 29-34
- The burden of illness in the first year home: Do male and female VA users differ in health conditions and healthcare utilization?.Women's Health Issues. 2011; 21: 92-97
- Leading the nation in women's health: The important role of research.Women's Health Issues. 2011; 21: S70-S72
- Deaths: Leading causes for 2006.National Center for Health Statistics, Hyattsville, MD2010
- Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan.JAMA. 2006; 295: 1023-1032
- Veterans' access to and use of Medicare and Veterans Affairs health care.Medical Care. 2007; 45: 214-223
- Health-related quality of life in patients served by the Department of Veterans Affairs: Results from the Veterans Health Study.Archives of Internal Medicine. 1998; 158: 626-632
- The Veterans Health Administration and military sexual trauma.American Journal of Public Health. 2007; 97: 2160-2166
- Extreme makeover: Transformation of the Veterans Health Care System.Annual Review of Public Health. 2009; 30: 313-339
- Use of outpatient care in Veterans Health Administration and Medicare among veterans receiving primary care in community-based and hospital outpatient clinics.Health Services Research. 2010; 45: 1268-1286
- Pregnancy and mental health among women veterans returning from Iraq and Afghanistan.Journal of Womens Health (Larchmt). 2010; 19: 2159-2166
- Actual causes of death in the United States.JAMA. 2004; 291: 1238-1245
- Health, United States, 2010: With special feature on death and dying.Author, Hyattsville, MD2011
- Relationship between clinical conditions and use of Veterans Affairs health care among Medicare-enrolled veterans.Health Services Research. 2010; 45: 762-791
- Estimating the costs of VA ambulatory care.Medical Care Research Review. 2003; 60: 54S-73S
- The cost of health conditions in a health maintenance organization.Medical Care Research Review. 2000; 57: 92-109
- Trends and risk factors for mental health diagnoses among Iraq and Afghanistan Veterans using Department of Veterans Affairs Health Care, 2002–2008.American Journal of Public Health. 2009; 99: 1-8
- VHA enrollees' health care coverage and use of care.Medical Care Research Review. 2003; 60: 253-267
- Gender differences in smoking cessation services received among veterans.Women's Health Issues. 2005; 15: 126-133
- Concordance between respondent self-reports and medical records for chronic conditions: experience from the Veterans Health Study.J Ambulatory Care Management. 2005; 28: 102-110
- Transition to the new race/ethnicity data collection standards in the Department of Veterans Affairs.Population Health Metrics. 2006; 4: 7
Veterans Health Administration. (2007). Pain as the 5th vital sign toolkit. Retrieved March 31, 2007, from http://www1.va.gov/.
- Using average cost methods to estimate encounter-level costs for medical-surgical stays in the VA.Medical Care Research Review. 2003; 60: 15S-36S
- Evaluation of trends in the cost of initial cancer treatment.Journal of the National Cancer Institute. 2008; 100: 888-897
- To use or not to use. What influences why women veterans choose VA Health Care.Journal of General Internal Medicine. 2006; 21: S11-S18
- Diffusion of innovation in women's health care delivery: The Department of Veterans Affairs' adoption of women's health clinics.Womens Health Issues. 2006; 16: 226-235
- Recent trends in Veterans Affairs chronic condition spending.Population Health Management. 2011; 14: 293-298
- Prevalence and costs of chronic conditions in the VA health care system.Medical Care Research Review. 2003; 60: 146S-167S
- Average cost of VA rehabilitation, mental health, and long-term hospital stays.Medical Care Research Review. 2003; 60: 40S-53S
Biography
Jean Yoon is a Health Economist in the VA Palo Alto, Menlo Park, CA. Her research interests involve chronic disease care and incentives for patients and providers in the management of disease.
Biography
Jennifer Y. Scott was a Statistical Analyst in the VA Palo Alto, Menlo Park, CA during the writing of this paper. Her research interests involve statistical analysis of cost data.
Biography
Ciaran S. Phibbs is a Health Economist in the VA Palo Alto, Menlo Park, CA and in Stanford University, Stanford, CA. He conducts research on perinatal care, nurse staffing, and hospital markets.
Biography
Susan M. Frayne is an Investigator in the VA Palo Alto, Menlo Park, CA and in the Division of General Internal Medicine, Stanford University, Stanford, CA. Her research includes mental illness, PTSD, and violence against women.
Article Info
Publication History
Accepted:
March 9,
2012
Received in revised form:
February 15,
2012
Received:
August 2,
2011
Identification
Copyright
Published by Elsevier Inc.
