Health care expenditures for urban and rural veterans in Veterans Health Administration care.

Objective: To compare Veterans Health Administration (VA) patients, non-VA-using veterans, and nonveterans, separated by urban/rural residence and age group, on their use of major categories of medical care and payment sources.

Data Source: Expenditures for health care-using men in Medical Expenditure Panel Surveys from 1996 through 2004.

Study Design: Retrospective, cross-sectional analysis.

Data Collection/extraction Methods: Controlling for demographics, health status, and insurance, we compared groups on population-weighted expenditures for inpatient, hospital-based outpatient, office-based, pharmacy, and other care, by major payers (self/family, private insurance, Medicare, other sources, and VA).

Results: VA users received most of their health care outside of the VA system, paid through private insurance or Medicare; self-payments were substantial. VA users under 65 reported worse health if they were rural residents but also lower expenditures overall and less care through private insurance.

Conclusions: VA health care users get most of their medical care from non-VA providers. Working-age VA users have less insurance coverage and rely more on VA care if they live in rural areas.