Abstract
Background
An increasing number of young women veterans are returning from war and military service
and are seeking reproductive health care from the Veterans Health Administration (VHA).
Many of these women seek maternity benefits from the VHA, and yet little is known
regarding the number of women veterans utilizing VHA maternity benefits nor the characteristics
of pregnant veterans using these benefits. In May 2010, VHA maternity benefits were
expanded to include 7 days of infant care, which may serve to entice more women to
use VHA maternity benefits. Understanding the changing trends in women veterans seeking
maternity benefits will help the VHA to improve the quality of reproductive care over
time.
Objective
The goal of this study was to examine the trends in delivery claims among women veterans
receiving VHA maternity benefits over a 5-year period and the characteristics of pregnant
veterans utilizing VHA benefits.
Design
We undertook a retrospective, national cohort study of pregnant veterans enrolled
in VHA care with inpatient deliveries between fiscal years (FY) 2008 and 2012.
Participants
We included pregnant veterans using VHA maternity benefits for delivery.
Main Measures
Measures included annualized numbers and rates of inpatient deliveries and delivery-related
costs, as well as cesarean section rates as a quality indicator.
Key Results
During the 5-year study period, there was a significant increase in the number of
deliveries to women veterans using VHA maternity benefits. The overall delivery rate
increased by 44% over the study period from 12.4 to 17.8 deliveries per 1,000 women
veterans. A majority of women using VHA maternity benefits were age 30 or older and
had a service-connected disability. From FY 2008 to 2012, the VHA paid more than $46 million
in delivery claims to community providers for deliveries to women veterans ($4,993/veteran).
Conclusions
Over a 5-year period, the volume of women veterans using VHA maternity benefits increased
by 44%. Given this sizeable increase, the VHA must increase its capacity to care for
pregnant veterans and ensure care coordination systems are in place to address the
needs of pregnant veterans with service-connected disabilities.
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Biography
Kristin M. Mattocks, PhD, MPH, is Associate Chief of Staff for Research and Education at VA Central Western Massachusetts Healthcare System and Assistant Professor of Quantitative Health Sciences and Psychiatry at the University of Massachusetts Medical School.
Biography
Susan Frayne, MD, MPH, is an associate professor of medicine at the VA Palo Alto Health Care System and a Stanford Health Policy Associate.
Biography
Ciaran S. Phibbs, PhD, is a Research Economist at the VA Health Economics Resource Center, an Investigator at the HSR&D Center for Innovation to Implementation, Associate Director of the Women's Health Evaluation Initiative, and Associate Director of the Geriatrics and Extended Care Data and Analysis Center, at the VA Palo Alto Health Care System. He is also an Associate Professor of Pediatrics (Neonatology) at the Stanford University School of Medicine and a recognized expert in perinatal epidemiology.
Biography
Elizabeth M Yano, PhD, MSPH, is Director of the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy at the VA Greater Los Angeles Healthcare System and Professor of Health Policy and Management at the UCLA Fielding School of Public Health. She is a VA Senior Research Career Scientist awardee and nationally recognized expert in women Veterans' research.
Biography
Laurie Zephyrin, MD, MPH, MBA is the Director of Reproductive Health at the Department of Veterans Affairs. She is also a Clinical Assistant Professor of Obstetrics and Gynecology at New York University School of Medicine.
Biography
Holly Shryock is a Senior Data Analyst for the Chief Business Office for Purchased Care. She has worked with the Non-VA Purchased Care Program and Non-VA Purchased Care data for over a decade and currently oversees national Non-VA Care data and corresponding analysis.
Biography
Sally Haskell, MD, is the Deputy Chief Consultant for Women’s Health Service and Director of Comprehensive Women's Health for the Veterans Health Administration. She is a General Internist, Women's Health Services Researcher, and Associate Professor of Medicine Yale School of Medicine. She is Co-Principal Investigator on the Women Veteran's Cohort Study, and Director of the VA Connecticut Advanced Fellowship in Women's Health.
Biography
Jodie Katon, MS, PhD, is a Research Health Scientist at VA Puget Sound Health Care System. She also serves as Senior Epidemiology Consultant for the VA Office of Women's Health Services.
Biography
J. Cherry Sullivan, MPH, is a Research Health Science Specialist at VA Central Western Massachusetts Healthcare System. She also serves as an adjunct instructor in the School of Public Health and Health Sciences at the University of Massachusetts, Amherst.
Biography
Linda Weinreb, MD, is Vice Chair of the Department of Family Medicine and Community Health, Professor of Family Medicine and Community Health, and Pediatrics at the University of Massachusetts Medical School. Dr. Weinreb also serves as the Joy McCann Endowed Professor for Women in Medicine.
Biography
Christine Ulbricht, MPH, is a PhD candidate in the Graduate School of Biomedical Sciences' Clinical & Population Health Research program at the University of Massachusetts Medical School, Worcester.
Biography
Lori A. Bastian MD, MPH, is a Senior Research Associate at VA Connecticut Healthcare System in health services research. She is also a Professor, Division Chief of General Internal Medicine, and Associate Dean for Career Development at the University of Connecticut Health Center.
Article Info
Publication History
Accepted:
October 11,
2013
Received in revised form:
October 9,
2013
Received:
February 7,
2013
Identification
Copyright
Published by Elsevier Inc.
