Local Area Unemployment and the Demand for Inpatient Care Among Veterans Affairs Enrollees

Prior research examining the relationship between economic conditions and health service demand has focused primarily on outpatient use. This study examines whether local area unemployment, as an indicator of economic conditions, was associated with use of inpatient care, which is theoretically less...

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Bibliographic Details
Published in:Medical care research and review 2015-08, Vol.72 (4), p.468-480
Main Authors: Wong, Edwin S., Hebert, Paul L., Nelson, Karin M., Hernandez, Susan E., Sylling, Philip W., Fihn, Stephan D., Liu, Chuan-Fen
Format: Article
Language:English
Subjects:
Aged
Economic conditions
Economics
Female
Government programs
Health Services Needs and Demand
Hospitalization
Hospitals, Veterans - economics
Hospitals, Veterans - utilization
Humans
Inpatient care
Male
Medicare
Medicare - economics
Primary Health Care - economics
Primary Health Care - utilization
Unemployment
Unemployment - statistics & numerical data
United States
Veterans
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Summary:Prior research examining the relationship between economic conditions and health service demand has focused primarily on outpatient use. This study examines whether local area unemployment, as an indicator of economic conditions, was associated with use of inpatient care, which is theoretically less subject to discretionary use. Using a random sample of 131,603 patients dually enrolled in the Veterans Affairs (VA) Health System and fee-for-service Medicare, we measured VA, Medicare, and total (VA and Medicare) hospitalizations. Overall, local unemployment was not associated with VA, Medicare, or total hospitalization probability. Among low-income veterans exempt from VA copayments, higher local unemployment was moderately associated with a lower probability of hospitalization through Medicare. For veterans subject to VA copayments, higher local unemployment was moderately associated with a higher likelihood of VA hospitalization. These results suggest inpatient use is less sensitive to the economy, although worse economic conditions slightly affected inpatient demand for select veterans.
ISSN:1077-5587
1552-6801
DOI:10.1177/1077558715583790