RESUMEN
CONTEXT: In the Veterans Health Administration (VHA), regionalization of high-technology health care services may influence veterans who live far from referral centers to obtain care locally, through the private sector. PURPOSE: To understand veterans' system-of-care preferences for a high-technology regionalized service. METHODS: The charts of 142 veterans who were referred for percutaneous transluminal coronary angioplasty (PTCA) by their VHA cardiologists were reviewed. FINDINGS: Fifty-two percent of these veterans obtained the procedure outside the VHA system. Insurance coverage and out-of-pocket costs were strongly associated with veterans' obtaining PTCA outside of the VHA system; travel distance was not. CONCLUSIONS: As the VHA begins to understand veterans' use of multiple systems of care, it will be important to understand the relationship between out-of-pocket costs and the system of care used for high-technology health care services.
Asunto(s)
Angioplastia de Balón/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/organización & administración , Aceptación de la Atención de Salud/estadística & datos numéricos , Sector Privado/estadística & datos numéricos , Regionalización/organización & administración , United States Department of Veterans Affairs/organización & administración , Angioplastia de Balón/economía , Financiación Personal , Investigación sobre Servicios de Salud , Humanos , Cobertura del Seguro , Masculino , Persona de Mediana Edad , Sector Privado/economía , Estados Unidos , VermontRESUMEN
We wanted to determine what factors were associated with rural veterans' use of Department of Veterans Affairs (VA) facilities over the private sector for coronary artery bypass grafting (CABG) surgery. We reviewed the charts of 137 veterans who were referred for CABG by their VA cardiologists. Most veterans (69%) obtained CABG through the VA system. Although patients who had to drive fewer additional miles to obtain VA care were somewhat more likely to use the VA system, patients who lacked insurance or faced high out-of-pocket cost estimates for care in the private sector obtained care through the VA at dramatically higher rates. Although patients using the VA system were younger and more likely to have significant coronary artery disease, clinical outcomes did not significantly differ across systems of care. As the VA begins to understand veterans' use of multiple systems of care, it will be important to understand what influences veterans' choice of VA or private sector care.