Article

Gender disparities in Veterans Health Administration care: importance of accounting for veteran status.

Center for Health Care Evaluation, 795 Willow Road (152-MPD), Menlo Park CA 94025, USA.
Medical Care (Impact Factor: 2.94). 06/2008; 46(5):549-53. DOI: 10.1097/MLR.0b013e3181608115
Source: PubMed

ABSTRACT 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.
Cross-sectional.
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.

Download full-text

Full-text

Available from: Elizabeth M Yano, Aug 21, 2014
1 Follower
 · 
137 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this paper is to report on the outcomes of the 2010 VA Women's Health Services Research Conference, which brought together investigators interested in pursuing research on women veterans and women in the military with leaders in women's health care delivery and policy within and outside the VA, to significantly advance the state and future direction of VA women's health research and its potential impacts on practice and policy. Building on priorities assembled in the previous VA research agenda (2004) and the research conducted in the intervening six years, we used an array of approaches to foster research-clinical partnerships that integrated the state-of-the-science with the informational and strategic needs of senior policy and practice leaders. With demonstrated leadership commitment and support, broad field-based participation, strong interagency collaboration and a push to accelerate the move from observational to interventional and implementation research, the Conference provided a vital venue for establishing the foundation for a new research agenda. In this paper, we provide the historical evolution of the emergence of women veterans' health services research and an overview of the research in the intervening years since the first VA women's health research agenda. We then present the resulting VA Women's Health Research Agenda priorities and supporting activities designed to transform care for women veterans in six broad areas of study, including access to care and rural health; primary care and prevention; mental health; post deployment health; complex chronic conditions, aging and long-term care; and reproductive health.
    Women s Health Issues 07/2011; 21(4 Suppl):S73-83. DOI:10.1016/j.whi.2011.04.002 · 1.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A new method for characterizing surface topography using a 2-dimensional discrete wavelet transform (2-D DWT) has been developed. The wavelet transform (WT) is the basis for a wide range of techniques applied in image processing and pattern recognition. Its main advantages over other feature extraction methods are the space-frequency localization, and the multi-resolution view of the frequency components of a signal. In this paper, an automatic grinding modes classification technique using a 2-D DWT is introduced, and comparisons of automatic grinding modes classification and human eye inspection are also examined
    Emerging Technologies and Factory Automation, 1996. EFTA '96. Proceedings., 1996 IEEE Conference on; 12/1996
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to compare gender differences in mental health disease burden and outpatient mental health utilization among veterans utilizing Veterans Health Administration (VHA) mental health services in fiscal year 1999 (FY99), after the first Gulf War and significant restructuring of VHA services. We used logistic regression to examine the relationships among gender, age, diagnostic groups, and utilization of mental health and specialty mental health services in a national sample of veterans. The sample included 782,789 veterans with at least 1 outpatient visit in the VHA in FY99 associated with a mental health or substance abuse (SA) diagnosis. Subgroup analyses were performed for 4 diagnostic categories: 1) posttraumatic stress disorder (PTSD), 2) SA disorders, 3) bipolar and psychotic disorders, and 4) mood and anxiety disorders. Younger women veterans (<35 years old) were significantly less likely and older women (> or =35) more likely to use any mental health services in comparison with their male counterparts. Similar findings were observed for younger women diagnosed with SA or mood and anxiety disorders, but not among veterans with PTSD or bipolar and psychotic disorders, among whom no there were no gender or age differences. In the case of specialized services for SA or PTSD, women younger than 55 with SA or PTSD were significantly less likely to use services than men. Women veterans underutilized specialty mental health services in relation to men but receipt of mental health care overall in FY99 varied by age and diagnosis. Examining gender differences alone, without taking other factors into account, may not provide an adequate picture of women veterans' current mental health service needs.
    Women s Health Issues 05/2009; 19(3):176-84. DOI:10.1016/j.whi.2009.03.002 · 1.61 Impact Factor