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AJPH First Look, published online ahead of print Oct 30, 2007
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December 2007, Vol 97, No. 12 | American Journal of Public Health 2179-2185
© 2007 American Public Health Association
DOI: 10.2105/AJPH.2007.114934

RESEARCH AND PRACTICE

Use of Preventive Care by Elderly Male Veterans Receiving Care Through the Veterans Health Administration, Medicare Fee-for-Service, and Medicare HMO Plans

Salomeh Keyhani, MD, MPH, Joseph S. Ross, MD, MHS, Paul Hebert, PhD, Cornelia Dellenbaugh, MPH, Joan D. Penrod, PhD and Albert L. Siu, MD, MSPH

Salomeh Keyhani is with the Health Services Research and Development (HSR&D) Targeted Research Enhancement Program, James J. Peters Veterans Administration Medical Center, New York, NY, and the Department of Health Policy, Mount Sinai School of Medicine, New York, NY. Joseph S. Ross, Cornelia Dellenbaugh, Joan D. Penrod, and Albert L. Siu are with the HSR&D Targeted Research Enhancement Program, James J. Peters Veterans Administration Medical Center, New York, and the Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York. Paul Hebert is with the Department of Health Policy, Mount Sinai School of Medicine, New York.

Correspondence: Requests for reprints should be sent to Salomeh Keyhani, MD, MPH, Department of Health Policy, Mount Sinai School of Medicine, Box 1077, 1 Gustave L. Levy Pl, New York, NY 10029 (e-mail: salomeh.keyhani{at}mountsinai.org).

Objectives. We compared use of preventive care among veterans receiving care through the Veterans Health Administration (VHA), Medicare fee-for-service (FFS) plans, and Medicare health maintenance organizations (HMOs).

Methods. Using both the Costs and Use, and Access to Care files of the Medicare Current Beneficiary Survey (2000–2003), we performed a cross-sectional analysis examining self-reported use of influenza vaccination, pneumococcal vaccination, serum cholesterol screening, and serum prostate-specific antigen measurement among male veterans 65 years or older. Veterans’ care was categorized as received through VHA, Medicare FFS, Medicare HMOs, VHA and Medicare FFS, or VHA and Medicare HMOs.

Results. Veterans receiving care through VHA reported 10% greater use of influenza vaccination (P<.05), 14% greater use of pneumococcal vaccination (P<.01), a nonsignificant 6% greater use of serum cholesterol screening (P=.1), and 15% greater use of prostate cancer screening (P<.01) than did veterans receiving care through Medicare HMOs. Veterans receiving care through Medicare FFS reported less use of all 4 preventive measures (P<.01) than did veterans receiving care through Medicare HMOs.

Conclusions. Receiving care through VHA was associated with greater use of preventive care.






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