Is There a VA Advantage? Evidence from Dually Eligible Veterans

Area of Science:

• Health Services Research
• Geriatric Medicine
• Public Health Policy

Background:

• Older veterans (65+) are eligible for care through the US Department of Veterans Affairs (VA) or private hospitals funded by Medicare.
• Understanding the comparative effectiveness and efficiency of these distinct healthcare systems is crucial for resource allocation and patient outcomes.

Purpose of the Study:

• To compare the impact of VA healthcare versus Medicare-financed private care on mortality and spending for veterans aged 65 and older.
• To identify potential factors contributing to differences in outcomes and service delivery between the two systems.

Main Methods:

• Utilized an "ambulance design" (Doyle et al., 2015) to analyze quasi-experimental variation in healthcare access.
• Compared 28-day mortality rates and healthcare expenditures between veterans receiving VA care and those receiving private care.

Main Results:

• The VA system was associated with a 46% reduction (4.5 percentage points) in 28-day mortality, with persistent survival gains.
• The VA also demonstrated a 21% reduction in 28-day spending compared to private care.
• Significant differences were observed in reported services between VA and private hospitals.

Conclusions:

• The VA healthcare system offers significant survival benefits and cost savings for older veterans compared to private Medicare-financed care.
• Evidence suggests potential complementarities between continuity of care, health information technology (IT), and integrated care models within the VA system.