Research Article
No access
Published Online: 8 December 2011

Recent Trends in Veterans Affairs Chronic Condition Spending

Publication: Population Health Management
Volume 14, Issue Number 6

Abstract

The change in prevalence and total Veterans Affairs (VA) spending were estimated for 16 chronic condition categories between 2000 and 2008. The drivers of changes in spending also were examined. Chronic conditions were identified through diagnoses in encounter records, and treatment costs per patient were estimated using VA cost data and regression models. The estimated differences in total VA spending between 2000 and 2008 and the contributions of population increase, differences in prevalence, and differences in treatment costs were evaluated. Most of the spending increases during the study period were driven by the increase in the VA patient population from 3.3 million in 2000 to 4.9 million in 2008. Spending on renal failure increased the most, by more than $1.5 billion, primarily because of higher prevalence. Higher treatment costs did not contribute much to higher spending; lower costs per patient for several conditions may have helped to slow spending for diabetes, chronic obstructive pulmonary disease, heart conditions, renal failure, dementia, and stroke. Lowering treatment costs per patient for common conditions can help slow spending for chronic conditions, but most of the increase in spending in the study period was the result of more patients seeking care from VA providers and the higher prevalence of conditions among patients. As the VA patient population continues to age and to develop more co-morbidities, and as returning veterans seek care for service-related problems, higher spending on chronic conditions will become a more prominent issue for the VA health care system. (Population Health Management 2011;14:293–298)

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Yu WRavelo AWagner TH et al. Prevalence and costs of chronic conditions in the VA health care systemMed Care Res Rev200360146S-167S. 1. Yu W, Ravelo A, Wagner TH, et al. Prevalence and costs of chronic conditions in the VA health care system. Med Care Res Rev. 2003;60:146S–167S.
2.
Wilson NJKizer KW. The VA health care system: An unrecognized national safety netHealth Aff (Millwood)199716200-204. 2. Wilson NJ, Kizer KW. The VA health care system: An unrecognized national safety net. Health Aff (Millwood). 1997;16:200–204.
3.
Seal KHMetzler TJGima KSBertenthal DMaguen SMarmar CR. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002–2008Am J Public Health2009991651-1658. 3. Seal KH, Metzler TJ, Gima KS, Bertenthal D, Maguen S, Marmar CR. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002–2008. Am J Public Health. 2009;99:1651–1658.
4.
Thorpe KEHoward DH. The rise in spending among Medicare beneficiaries: The role of chronic disease prevalence and changes in treatment intensityHealth Aff (Millwood)200625w378-w388. 4. Thorpe KE, Howard DH. The rise in spending among Medicare beneficiaries: The role of chronic disease prevalence and changes in treatment intensity. Health Aff (Millwood). 2006;25:w378–w388.
5.
Kizer KWDudley RA. Extreme makeover: Transformation of the veterans health care systemAnn Rev Public Health200930313-339. 5. Kizer KW, Dudley RA. Extreme makeover: Transformation of the veterans health care system. Ann Rev Public Health. 2009;30:313–339.
6.
Ashton CMSouchek JPetersen NJ et al. Hospital use and survival among Veterans Affairs beneficiariesN Engl J Med20033491637-1646. 6. Ashton CM, Souchek J, Petersen NJ, et al. Hospital use and survival among Veterans Affairs beneficiaries. N Engl J Med. 2003;349:1637–1646.
7.
Ray GTCollin FLieu T et al. The cost of health conditions in a health maintenance organizationMed Care Res Rev20005792-109. 7. Ray GT, Collin F, Lieu T, et al. The cost of health conditions in a health maintenance organization. Med Care Res Rev. 2000;57:92–109.
8.
Fishman PVon Korff MLozano PHecht J. Chronic care costs in managed careHealth Aff (Millwood)199716239-247. 8. Fishman P, Von Korff M, Lozano P, Hecht J. Chronic care costs in managed care. Health Aff (Millwood). 1997;16:239–247.
9.
Cohen BEGima KBertenthal DKim SMarmar CRSeal KH. Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veteransJ Gen Intern Med20102518-24. 9. Cohen BE, Gima K, Bertenthal D, Kim S, Marmar CR, Seal KH. Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans. J Gen Intern Med. 2010;25:18–24.
10.
Dominitz JABoyko EJKoepsell TD et al. Elevated prevalence of hepatitis C infection in users of United States veterans medical centersHepatology20054188-96. 10. Dominitz JA, Boyko EJ, Koepsell TD, et al. Elevated prevalence of hepatitis C infection in users of United States veterans medical centers. Hepatology. 2005;41:88–96.
11.
US Department of Veterans Affairs. Quality Enhancement Research Initiative (QUERI)http://www.queri.research.va.gov/January102011. 11. US Department of Veterans Affairs. Quality Enhancement Research Initiative (QUERI). Available at: http://www.queri.research.va.gov/. Accessed January 10, 2011.
12.
Demakis JGMcQueen LKizer KWFeussner JR. Quality Enhancement Research Initiative (QUERI): A collaboration between research and clinical practiceMed Care200038I17-I25. 12. Demakis JG, McQueen L, Kizer KW, Feussner JR. Quality Enhancement Research Initiative (QUERI): A collaboration between research and clinical practice. Med Care. 2000;38:I17–I25.
13.
Wagner THChen SBarnett PG. Using average cost methods to estimate encounter-level costs for medical-surgical stays in the VAMed Care Res Rev20036015S-36S. 13. Wagner TH, Chen S, Barnett PG. Using average cost methods to estimate encounter-level costs for medical-surgical stays in the VA. Med Care Res Rev. 2003;60:15S–36S.
14.
Yu WWagner THChen SBarnett PG. Average cost of VA rehabilitation, mental health, and long-term hospital staysMed Care Res Rev20036040S-53S. 14. Yu W, Wagner TH, Chen S, Barnett PG. Average cost of VA rehabilitation, mental health, and long-term hospital stays. Med Care Res Rev. 2003;60:40S–53S.
15.
Phibbs CSBhandari AYu WBarnett PG. Estimating the costs of VA ambulatory careMed Care Res Rev20036054S-73S. 15. Phibbs CS, Bhandari A, Yu W, Barnett PG. Estimating the costs of VA ambulatory care. Med Care Res Rev. 2003;60:54S–73S.
16.
Frank RBerndt EBusch S. Price indexes for the treatment of depressionTriplett JMeasuring the Prices of Medical TreatmentsWashington, DCBrookings Institution Press1999. 16. Frank R, Berndt E, Busch S. Price indexes for the treatment of depression. In: Triplett J, ed. Measuring the Prices of Medical Treatments. Washington, DC: Brookings Institution Press; 1999.
17.
Copas JB. Regression, prediction and shrinkage. J Royal Stat SoSeries B (Methodological)198345311-354. 17. Copas JB. Regression, prediction and shrinkage. J Royal Stat So. Series B (Methodological). 1983;45:311–354.
18.
Decker SLSchappert SMSisk JE. Use of medical care for chronic conditionsHealth Aff (Millwood)20092826-35. 18. Decker SL, Schappert SM, Sisk JE. Use of medical care for chronic conditions. Health Aff (Millwood). 2009;28:26–35.
19.
Zhu CWPenrod JDRoss JSDellenbaugh CSano M. Use of Medicare and Department of Veterans Affairs health care by veterans with dementia: A longitudinal analysisJ Am Geriatr Soc2009571908-1914. 19. Zhu CW, Penrod JD, Ross JS, Dellenbaugh C, Sano M. Use of Medicare and Department of Veterans Affairs health care by veterans with dementia: A longitudinal analysis. J Am Geriatr Soc. 2009;57:1908–1914.
20.
Manton KGu XUkraintseva S. Declining prevalence of dementia in the U.S. elderly populationAdv Gerontol20051630-37. 20. Manton K, Gu X, Ukraintseva S. Declining prevalence of dementia in the U.S. elderly population. Adv Gerontol. 2005;16:30–37.
21.
Nurmohamed MTDijkmans BA. Efficacy, tolerability and cost effectiveness of disease-modifying antirheumatic drugs and biologic agents in rheumatoid arthritisDrugs200565661-694. 21. Nurmohamed MT, Dijkmans BA. Efficacy, tolerability and cost effectiveness of disease-modifying antirheumatic drugs and biologic agents in rheumatoid arthritis. Drugs. 2005;65:661–694.
22.
VA boosts services and research in spinal cord injury [press release]Washington, DCVHA Office of Research and DevelopmentJune192007. 22. VA boosts services and research in spinal cord injury [press release]. Washington, DC: VHA Office of Research and Development; June 19, 2007.
23.
Liu CFChapko MBryson CL et al. Use of outpatient care in Veterans Health Administration and Medicare among veterans receiving primary care in community-based and hospital outpatient clinicsHealth Serv Res2010451268-1286. 23. Liu CF, Chapko M, Bryson CL, et al. Use of outpatient care in Veterans Health Administration and Medicare among veterans receiving primary care in community-based and hospital outpatient clinics. Health Serv Res. 2010;45:1268–1286.

Information & Authors

Information

Published In

cover image Population Health Management
Population Health Management
Volume 14Issue Number 6December 2011
Pages: 293 - 298
PubMed: 22044350

History

Published online: 8 December 2011
Published in print: December 2011
Published ahead of print: 1 November 2011

Permissions

Request permissions for this article.

Topics

Authors

Affiliations

Jean Yoon, PhD, MHS
Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California.
Jennifer Y. Scott, MS
Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California.
Ciaran S. Phibbs, PhD
Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California.
Department of Health Research and Policy, Stanford University, Stanford, California.
Department of Pediatrics, Stanford University, Stanford, California.
Todd H. Wagner, PhD
Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California.
Department of Health Research and Policy, Stanford University, Stanford, California.

Notes

Address correspondence to:Jean YoonHealth Economics Resource CenterVA Palo Alto Health Care System795 Willow Rd (152 MPD)Menlo Park, CA 94025E-mail: [email protected]

Author Disclosure Statement

Drs. Yoon, Phibbs, and Wagner, and Ms Scott disclosed no competing financial interests.

Metrics & Citations

Metrics

Citations

Export citation

Select the format you want to export the citations of this publication.

View Options

Get Access

Access content

To read the fulltext, please use one of the options below to sign in or purchase access.

Society Access

If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options

PDF/EPUB

View PDF/ePub

Full Text

View Full Text

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media

Back to Top