How Did Payer Shifts Impact Veteran Access to Private Care?

In a recent study, the objective was to examine the impact of expanded access to Veterans Affairs (VA)-purchased care on overall utilization and the potential shift from other payers to the VA for emergency care among VA enrollees. The researchers focused on emergency department (ED) encounters in the state of New York in 2019.

The study employed a difference-in-differences analysis, comparing VA enrollees to the general population before and after the implementation of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act in June 2019. 

The MISSION Act aimed to improve veterans' access to health care by allowing them to receive care from non-VA providers under certain circumstances.
The researchers collected data on all ED visits by individuals aged 30 or older in the sample, and individuals were considered eligible for the policy change if they were enrolled with the VA at the beginning of 2019.

The findings revealed that out of the 5,577,199 ED visits in the sample, 4.9% (n = 253,799) were made by VA enrollees. Among these visits, 44.9% were paid by Medicare, 32.8% occurred in VA facilities, and 7% were paid by private health insurance.

After the implementation of the MISSION Act, there was a significant decrease in the proportion of ED visits paid by Medicare among VA enrollees compared to the general population. Specifically, there was a 6.4% decrease in the proportion of Medicare-funded visits. This decrease was even more pronounced for ED visits that resulted in subsequent inpatient admissions, with an 8.4% decrease in Medicare-funded visits.

Importantly, there was no statistically significant change in the total volume of ED visits, indicating that the MISSION Act did not lead to an overall increase in ED utilization.

Based on these findings, the researchers concluded that the implementation of the MISSION Act coincided with a shift in the financing of non-VA ED visits from Medicare to the VA among VA enrollees. This shift suggests that expanded access to VA-purchased care led to a redirection of financial responsibility for emergency care. These results have significant implications for the financing and delivery of VA health care services.

Overall, this study highlights the impact of policy changes on health care utilization patterns among VA enrollees and emphasizes the importance of evaluating the effects of such interventions to inform future health care policies and improve veterans' access to care.

Reference:
Rose L, Tran D, Wu S, et all. Payer shifting after expansions in access to private care among veterans. Health Serv Res. Published online ahead of print, April 19, 2023. doi:10.1111/1475-6773.14162