November 21, 2014 - ABSTRACT
Starting in 2006, Massachusetts enacted a series of health insurance reforms that successfully led to 96.6% of its population being covered by 2011. As the rest of the nation undertakes similar reforms, it is unknown how the Veterans Health Administration (VHA), one of many important Federal health care programs, will be affected. Our state-level study approach assessed the effects of health reform on utilization of VHA services in Massachusetts from 2005 to 2011. Models were adjusted for state-level demographic and economic characteristics, including health insurance rates, unemployment rates, median household income, poverty rates, and percent of population 65 years and older. No statistically significant associative change was observed in Massachusetts relative to other states over this time period. The findings raise important questions about the continuing role of VHA in American health care as health insurance coverage is one of many factors that influence decisions on where to seek health care.
INTRODUCTION
snip RESULTS
From 2005 to 2011, the VHA user rate in Massachusetts increased from 17.4% to 23.6% (Fig. 1). The national VHA user rate increased by nearly the same amoimt, from 20.8% in 2005 to 26.5% in 2011. Although VHA utilization in Massachusetts remained below the national average over this period, the parallel increases in user rates were not signifi- cantly different (p = 0.598).
Compared to states that did not implement reforms in 2006-2007, no statistically significant change in the VHA user rate for Massachusetts was observed after controlling for demographic and economic characteristics (-0.35%, 95% Cl: -6.38% to 5.68%, p = 0.964). Additionally, no statistically significant relationship was observed between the VHA user rate and the population health insurance rate in unadjusted (p = 0.560) and adjusted (p = 0.746) models (Fig. 2).
VHA user rates increased for every state from 2005 to 2011, and similar increases were seen when adjusting for variation in demographic and economic characteristics between states, including unemployment rate, median house- hold income, poverty rate, and percent of population 65 years and older (Fig. 3). The increase in the VHA user rate in Massachusetts was toward the middle of the national distri- bution, ranked 17th out of 50 states over this time period.
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