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Judith A. Long, MD, Daniel Polsky, PhD and Joshua P. Metlay, MD, PhD

Judith A. Long and Joshua P. Metlay are with the Philadelphia Veterans Affairs Center for Health Equity Research and Promotion, the University of Pennsylvania’s Leonard Davis Institute of Health Economics, and the Department of Medicine of the University of Pennsylvania’s School of Medicine, Philadelphia. Daniel Polsky is with the University of Pennsylvania’s Leonard Davis Institute of Health Economics and the Department of Medicine of the University of Pennsylvania’s School of Medicine.

Correspondence: Requests for reprints should be sent to Judith A. Long, MD, University of Pennsylvania School of Medicine, 1201 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021 (e-mail jalong{at}mail.med.upenn.edu).

Objectives. During the mid-1990s, the Veterans Health Administration (VHA) reorganized and placed greater emphasis on high-quality primary care. To determine whether the reorganization was associated with changes in patterns of out-patient VHA use, we sought to evaluate changes in characteristics of veterans who use VHA outpatient services between 1992 and 2000.

Methods. We merged 2 waves of the National Survey of Veterans to determine changes in patterns of outpatient care use. We evaluated the extent to which veterans who received outpatient care received that care from the VHA.

Results. The odds ratio for VHA-only outpatient care relative to non-VHA–only care in 2000 relative to 1992 was 1.75 (95% confidence interval [CI]=1.51, 2.04), and the odds ratio for dual relative to non-VHA-only care was 1.22 (95% CI=1.08, 1.37). Veterans who were older, had low incomes, and had no additional health insurance coverage were most likely to increase their use of VHA outpatient care.

Conclusions. Our results suggest that the VHA is increasingly serving veterans who have trouble accessing the private health care system.

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