Gender Disparities in Veterans Health Administration Care

Center for Health Care Evaluation, 795 Willow Road (152-MPD), Menlo Park CA 94025, USA.
Medical Care (Impact Factor: 3.23). 06/2008; 46(5):549-53. DOI: 10.1097/MLR.0b013e3181608115
Source: PubMed


In an effort to assess and reduce gender-related quality gaps, the Veterans Health Administration (VHA) has promoted gender-based research. Historically, such appraisals have often relied on secondary databases, with little attention to methodological implications of the fact that VHA provides care to some nonveteran patients.
To determine whether conclusions about gender differences in utilization and cost of VHA care change after accounting for veteran status.
All users of VHA in 2002 (N = 4,429,414).
Veteran status, outpatient/inpatient utilization and cost, from centralized 2002 administrative files.
Nonveterans accounted for 50.7% of women (the majority employees) but only 3.0% of men. Among all users, outpatient and inpatient utilization and cost were far lower in women than in men, but in the veteran subgroup these differences decreased substantially or, in the case of use and cost of outpatient care, reversed. Utilization and cost were very low among women employees; women spouses of fully disabled veterans had utilization and costs similar to those of women veterans.
By gender, nonveterans represent a higher proportion of women than of men in VHA, and some large nonveteran groups have low utilization and costs; therefore, conclusions about gender disparities change substantially when veteran status is taken into account. Researchers seeking to characterize gender disparities in VHA care should address this methodological issue, to minimize risk of underestimating health care needs of women veterans and other women eligible for primary care services.

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Available from: Elizabeth M Yano, Aug 21, 2014
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    • "In our data, agreement between the medical record and self-report was higher for non-VA users, 86.4% (Study1) than for VA users 56.9% (Study 2). However, because women VA users often receive medical care in non-VA facilities, the lower percent agreement among VA users may be explained (at least in part) by the receipt of mammograms from non-VA providers rather than inaccurate reporting or recall (Frayne, et al, 2008, Murdoch, et al, 2006). VA and private users compared to similar studies in the literature were better than Zapka et al (31%) for exact agreement (concordance) (Zapka, et al, 1996). "
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