Increasing use of medicare services by veterans with acute myocardial infarction

OBJECTIVES. Some of the nation's 26 million veterans have two government-fi nanced health care entitlements: Medicare and the Department of Veterans Af fairs (VA). The aims of this investigation were to examine trends where Med icare-eligible VA users are initially hospitalized for acute myocardial inf arction (AMI) and then to assess rates of cardiac procedure use and mortali ty for veterans initially admitted to each system of care. METHODS. We used VA and HCFA national databases to identify VA users (age r ange, greater than or equal to 65 years) who were initially admitted to a V AMC or Medicare financed hospital (Medicare hospital) with a primary diagno sis of AMI between January 1, 1992, and December 31, 1995, (n = 47,598). We examined the use of cardiac procedures (cardiac catheterization [CC] coron ary artery bypass surgery [CABG], and coronary angioplasty [CA] and mortali ty (30-day and 1-year) by the type of initial admitting hospital within eac h system of care, RESULTS. Almost 70% of VA users hospitalized for AMI were initially admitte d to Medicare hospitals versus VAMCs between 1992 (64%) and 1995 (72%). Aft er adjusting for patient characteristics in logistic models, VA users initi ally hospitalized in Medicare hospitals were significantly more likely to u ndergo cardiac procedures than were VA users hospitalized in VAMCs. Differe nces in the odds of receiving a procedure were most significant when compar ing Medicare hospitals with onsite cardiac technology to VA hospitals witho ut on-site cardiac technology (CC: OR 4.34, 95% CI 3.98-4.73; CABG: OR 2.16 , 95% CI 1.92-2.43; CA: OR 4.56, 95% CI 3.98-5.25). We found no significant differences in 30-day and 1-year adjusted mortality rates between VA users initially admitted to VAMCs or Medicare hospitals. CONCLUSIONS. Medicare-eligible VA users are increasingly hospitalized in Me dicare hospitals for AMI. VA users cared for in Medicare hospitals receive more cardiac procedures but have the same survival as VA users cared for in VAMCs. These findings have policy implications for access, quality, and co sts in both systems of care.