Volume 53 | Number S3 | December 2018

Abstract List

Chuan‐Fen Liu M.P.H., Ph.D., Adam Batten B.A., Edwin S. Wong Ph.D., Stephan D. Fihn, Paul L. Hebert Ph.D.


To examine the long‐term reliance on outpatient care at the population (i.e., system) level among fee‐for‐service Medicare‐enrolled elderly veterans in the Department of Veterans Affairs () health care system and Medicare from 2003 to 2014.

Data Sources/Study Setting

We analyzed a 5 percent random sample, stratified by facility, age, gender, and race, of Medicare‐enrolled veterans enrolled in a primary care panel using administrative data and Medicare claims.

Study Design

We performed a repeated cross‐sectional analysis over 48 quarters. reliance was defined at the system level as the proportion of total visits ( + Medicare) that occurred in . We examined four visit types and seven high‐volume medical subspecialties. We applied direct standardization adjusting for age, gender, and race using the 2010 population distribution of Medicare‐enrolled veterans.

Principal Findings

Over the 12‐year period, provided the vast majority of mental health care. Conversely, veterans received slightly more than half of their primary care and most of their specialty care, surgical care, and seven high‐volume medical subspecialties through Medicare. However, reliance on outpatient care steadily increased over time for all categories of care.


Despite the controversies about access to care, Medicare‐enrolled veterans, who have a choice of using or Medicare providers, appear to increase their use of care prior to the Choice Act.