Veterans' Use of Community Clinics vs. VA Medical Centers for Primary Care
Author Information
Author(s): Maciejewski Matthew L, Perkins Mark, Li Yu-Fang, Chapko Michael, Fortney John C, Liu Chuan-Fen
Primary Institution: Durham VA Medical Center
Hypothesis
Do veterans utilizing Community-Based Outpatient Clinics (CBOCs) have different healthcare utilization and expenditures compared to those using VA Medical Centers (VAMCs)?
Conclusion
CBOCs provided veterans improved access to primary care and other services, but expenditures were contained because CBOC patients who sought health care had fewer visits and hospital stays than comparable VAMC patients.
Supporting Evidence
- CBOC patients had more primary care visits per year than VAMC patients.
- CBOC patients had lower total outpatient and overall expenditures than VAMC patients.
- Distance to care was a significant factor affecting utilization and expenditures.
Takeaway
Veterans who go to community clinics see the doctor a little less often and spend less money than those who go to VA hospitals.
Methodology
The study analyzed data from 25,092 CBOC patients, 26,936 VAMC patients, and 11,450 crossover patients using VA's cost accounting system and regression models.
Potential Biases
Potential unmeasured covariates related to CBOC status and resource use could bias the results.
Limitations
The study did not randomize veterans to treatment sites, which may introduce selection bias, and lacked data on health outcomes and non-VA utilization.
Participant Demographics
CBOC patients were younger, more likely to be married, and had lower health risk scores compared to VAMC and crossover patients.
Statistical Information
P-Value
p<0.0001
Statistical Significance
p<0.0001
Digital Object Identifier (DOI)
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