Abstract
BackgroundIn the U.S., economic conditions are intertwined with labor market decisions, access to health care, health care utilization and health outcomes. The Veterans Affairs (VA) health care system has served as a safety net provider by supplying free or reduced cost care to qualifying veterans. This study examines whether local area labor market conditions, measured using county-level unemployment rates, influence whether veterans obtain health care from the VA.MethodsWe used survey data from the Behavioral Risk Factor Surveillance System in years 2000, 2003 and 2004 to construct a random sample of 73,964 respondents self-identified as veterans. VA health service utilization was defined as whether veterans received all, some or no care from the VA. Hierarchical ordered logistic regression was used to address unobserved state and county random effects while adjusting for individual characteristics. Local area labor market conditions were defined as the average 12-month unemployment rate in veterans’ county of residence.ResultsThe mean unemployment rate for veterans receiving all, some and no care was 5.56%, 5.37% and 5.24%, respectively. After covariate adjustment, a one percentage point increase in the unemployment rate in a veteran’s county of residence was associated with an increase in the probability of receiving all care (0.34%, p-value = 0.056) or some care (0.29%, p-value = 0.023) from the VA.ConclusionsOur findings suggest that the important role of the VA in providing health care services to veterans is magnified in locations with high unemployment.
Highlights
In the U.S, economic conditions are intertwined with labor market decisions, access to health care, health care utilization and health outcomes
The Veterans Affairs (VA) health care system has served as a health care safety net [2,3,4] for veterans by providing free or reduced cost care based on the level of military service-related disability, or by satisfying a financial means test
This study examined the relationship between the use of VA health care services by veterans and labor market conditions in their county of residence, measured using the county-level unemployment rate
Summary
In the U.S, economic conditions are intertwined with labor market decisions, access to health care, health care utilization and health outcomes. The Veterans Affairs (VA) health care system has served as a safety net provider by supplying free or reduced cost care to qualifying veterans. In the United States (U.S.), economic conditions are intertwined with labor market decisions, access to health care, health care utilization and expenditures, and health outcomes because of employment-based health insurance. Safety net systems, such as state Medicaid programs, are important sources of health care services during difficult economic periods when labor market conditions are weak. The Veterans Affairs (VA) health care system has served as a health care safety net [2,3,4] for veterans by providing free or reduced cost care based on the level of military service-related disability, or by satisfying a financial means test. VA is the largest integrated health care system in the U.S with a health care budget of $52
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