Where do veterans health administration patients obtain heart, liver, and kidney transplants?

We sought to determine whether Veterans Health Administration (VA) enrollees use the VA system or the private sector for solid-organ transplantation and whether VA system use is associated with patients' proximity to a VA transplant center. Using a national VA/Medicare inpatient data set and a comprehensive New York State VA/private-sector inpatient data set for 1998 to 2000, we found that veterans enrolled in the VA system obtained approximately one-half of their liver transplants, but few heart and kidney transplants, in the VA system. Patients were much more likely to use the VA system if they lived in a VA service area that offered relevant transplant services. Our findings suggest that VA transplant centers intended to meet national needs are more likely to serve local residents. Furthermore, our analysis indicates that use of only the VA/Medicare data set may substantially underestimate VA enrollees' reliance on the private sector for health care services.