Is Fragmented Financing Bad for Your Health?

Health Care Financing and Economics, U.S. Department of Veterans Affairs, 150 South Huntington Ave. (152H), Boston, MA 02130, USA.
Inquiry: a journal of medical care organization, provision and financing (Impact Factor: 0.55). 07/2011; 48(2):109-22. DOI: 10.2307/23035407
Source: PubMed


Americans finance health care through a variety of private insurance plans and public programs. This organizational fragmentation could threaten continuity of care and adversely affect outcomes. Using a large sample of veterans who were eligible for mixtures of Veterans Health Administration- and Medicare-financed care, we estimate a system of equations to account for simultaneity in the determination of financing configuration and the probability of hospitalization for an ambulatory care sensitive condition. We find that a change of one standard deviation in financing fragmentation increases the risk of an adverse outcome by one-fifth.

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    ABSTRACT: BACKGROUND: Many veterans have dual Veterans Administration (VA) and Medicare healthcare coverage. We compared 3-year overall and cancer event-free survival (OS; EFS) among patients with non-metastatic colon cancer who obtained substantial portions of their care in both systems and those whose care was obtained predominantly in the VA or in the Medicare fee-for-service system. METHODS: We conducted a retrospective observational cohort study of patients older than 65 years with stages I-III colon cancer diagnosed 1999-2001 in VA and non-VA facilities. Dual use of VA and non-VA colon cancer care was categorized as predominantly VA use, dual use, or predominantly non-VA use. Extended Cox regression models evaluated associations between survival and dual use. RESULTS: VA and non-VA users (all stages) had reduced hazard of dying compared to dual users (for example, for stage I, VA HR 0.40, CI95 0.28-0.56; non-VA HR 0.54, CI95 0.38-0.78). For EFS, stage I findings were similar (VA HR 0.47, CI95 0.35-0.62; non-VA HR 0.64, CI95 0.47-0.86). Stage II and III VA users, but not non-VA users, had improved EFS (Stage II: VA HR 0.74, CI95 0.56-0.97; non-VA HR 0.92 CI95 0.69-1.22. Stage III: VA HR 0.73, CI95 0.56-0.94; non-VA HR 0.81 CI95 0.62-1.06). CONCLUSIONS: Improved survival among VA and non-VA compared to dual users raises questions about coordination of care and unmet needs. IMPACT Additional study is needed to understand why these differences exist, why patients use both systems and how systems may be improved to yield better outcomes in this population.
    Cancer Epidemiology Biomarkers & Prevention 10/2012; 21(12). DOI:10.1158/1055-9965.EPI-12-0548 · 4.13 Impact Factor


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