Are patients at veterans affairs medical centers sicker? A comparative analysis of health status and medical resource use

Background: The Veterans Affairs (VA) health system has been criticized for bring inefficient based on comparisons of VA care with non-VA care. Whethe r such comparisons are biased by differences between the VA patient populat ion and the non-VA patient population is not known. Our objective is to det ermine if VA patients are different from non-VA patients in terms of health status and medical resource use. Method: We analyzed 128099 records from the National Health Interview Surve y for the years 1993 and 1994. We compared the VA patient population with t he general patient population for self report on health status, number of m edical conditions, number of outpatient physician visits, number of hospita l admissions, and number of hospital days each year. Results: The VA patient population had poorer health status (odds ratio [OR ], 14.7; 95% confidence interval [CI], 10.7-20.2), more medical conditions (OR, 14; 95% CI, 10.5-18.7), and higher medical resource use compared with the general patient population (OR, 3.7 for 3 or more physician visits per year; OR 5.4 for 3 or more hospital admissions per year; OR, 7.7 for 21 or more days spent in a hospital per year). However, after controlling for hea lth and sociodemographic differences, VA patients had similar resource use compared with the general patient population. Conclusion: Large differences in sociodemographic status, health status, an d subsequent resource use exist between the VA and the general patient popu lation. Therefore, comparisons of VA care with non-VA care need to take the se differences into account. Furthermore, health care planning and resource allocation within the VA should not be based on data extrapolated from non -VA patient populations.