6\. HEALTH CARE

This chapter discusses results from the NSV 2001 on use of health care
services. The NSV collected information about veterans' current health
insurance plans or programs, including Medicare (Part A, Part B);
Medicare managed care; HMO; Medigap/Medicare supplemental health
insurance; Medicaid (Medi-Cal); CHAMPUS; TRICARE; other government
health care programs; or private health insurance. Information was also
collected on veterans' use of VA and non-VA health care services within
the past 12 months. These included emergency room use, outpatient care
(number of visits), and inpatient care (number of overnights
hospitalized). Additionally, NSV collected data on how services were
paid for (CHAMPUS/TRICARE, HMO, Medicare, private health insurance, VA).
If VA health care benefits had not been used in the past year or were
not used, veterans were asked why they did not use them.

The Veterans Health Administration (VHA) is the nation's largest
integrated health care system. The VHA mission is to serve the needs of
America's veterans by providing primary care, specialized care, and
related medical and social support services. VHA employs approximately
180,000 health care professionals at 163 hospitals, more than 800
community and facility-based clinics, 135 nursing homes, 43
domiciliaries, 206 readjustment counseling centers, and various other
facilities. Historically, VA's health care has been provided through a
hospital-based delivery system. However, in recent years VHA
restructured health care delivery to emphasize managed care through an
extended network of community-based clinics and ambulatory care units.

Demographic trends indicate that VHA will continue to face the challenge
of providing efficient and effective long-term care and geriatric
services to an aging veteran population over the next decade. The
percentage of older veterans is increasing as the percentage of younger
veterans is declining.

# 6.1 Health Insurance Coverage

As seen in Table 6-1, veterans report having a number of health
insurance coverage types. These types fall into the following five major
modes:

Medicare,

Medigap or Medicare supplemental,

CHAMPUS or TRICARE,

Other government-provided health service plans, and

Private insurance.

Some veterans report more than one type of coverage. For example, some
report coverage by both Medicare and a supplemental Medigap plan.[^1]
The table also shows subsets of coverage within these major modes of
coverage, such as Medicare Part A only and Part B only coverage. Nearly
two out of three veterans (63.0 percent) report coverage by some form of
private insurance, either non-HMO (37.2 percent) or HMO (25.8 percent),
while more than one out of three (39.3 percent) report some form of
Medicare. Another type reported frequently was Medigap or Medicare
Supplemental insurance (18.0 percent). Ten percent of veterans did not
mention any insurance coverage.

**Health Care Priority Group and Health Insurance Coverage.** Table 6-1
also compares priority groups in terms of their insurance coverage. The
pattern of coverage varies by priority group. A larger percentage of
veterans in Priority 1, 4, and 5 report Medicare coverage than report
private coverage. The reverse is found among Priority 2, 3, 6, and 7,
where more veterans report coverage in private plans than in Medicare.

**Age and Health Insurance Coverage.** Health insurance varies by age
group, as shown in Table 6-2. For example, the proportion of veterans
reporting Medicare coverage increases across the age groups, while the
proportion of veterans with private health insurance decreases. The
percentage of veterans reporting no insurance coverage also decreased as
the age of veterans increased. Other types are mentioned by
proportionately more veterans in the middle age groups, compared to
oldest and youngest age groups (e.g., CHAMPUS or TRICARE).

Medicare eligibility criteria effectively separates the types of
coverage reported by the age of veterans. More than 95 percent of
veterans age 65 and older (96.0 percent) report Medicare coverage, while
only 5.5 percent of veterans under 65 do so. Table 6-3 displays
comparisons of health insurance coverage by veteran age, with age
divided into less than 65 years and 65 years or older. Nearly
three-quarters of younger veterans (74.7 percent) report some form of
private medical insurance, compared to only 43.3 percent of older
veterans. Younger veterans also reported no insurance coverage more
frequently than older veterans (15.3 percent versus 1.0 percent,
respectively).

Table 6-1. Percent distribution of veterans by type of insurance and
health care priority group

  --------------------- ------------ ---------- ---------- ----------- ---------- ----------- ----------- ------------
                        Total        Priority 1 Priority 2 Priority 3  Priority 4 Priority 5  Priority 6  Priority 7

  Medicare              39.3         47.1       36.5       38.2        75.0       57.1        19.7        36.2

  Medicare managed care 11.0         8.7        9.7        10.1        9.0\*      17.0        6.1         10.1
  or Medicare HMO                                                                                         

  Medicare Part A for   2.4          6.0        2.5        2.1         7.9\*      4.2         1.3         1.8
  hospital care only                                                                                      

  Medicare Part B for   1.0          1.3        0.9        0.9         5.7\*      1.9         0.4\*       0.8
  visits to doctor                                                                                        
  offices only                                                                                            

  Both Medicare Part A  24.2         28.0       22.8       24.5        52.8       32.9        11.4        23.2
  and Part B                                                                                              

  Medigap or Medicare   18.0         13.8       16.2       18.3        23.3\*     23.1        8.5         18.1
  Supplement health                                                                                       
  insurance plan                                                                                          

  Medicaid/Medi-Cal     3.5          3.1        3.2        3.4         13.4\*     14.6        0.0         0.0

  CHAMPUS or TRICARE    7.1          24.0       30.2       20.6        1.6\*      3.3         10.9        4.6

  Other                 3.5          8.2        9.5        6.1         1.7\*      2.9         3.6         3.0
  government-provided                                                                                     
  health insurance or                                                                                     
  health service plan                                                                                     

  Private Non-HMO       37.2         23.7       28.6       33.5        3.7\*      24.2        40.4        43.0

  Private HMO           25.8         11.3       19.5       23.1        1.3\*      13.1        35.6        30.1

  No insurance coverage 10.0         17.7       11.3       10.9        15.4       19.1        8.5         6.2
  mentioned                                                                                               

  Unknown               0.4          1.2        0.8\*      0.4\*       3.5\*      0.7         0.2\*       0.2

  Number of veterans†   25,196,000   719,400    580,900    1,441,600   29,000     5,326,400   2,828,300   14,125,600
  --------------------- ------------ ---------- ---------- ----------- ---------- ----------- ----------- ------------

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred;
the total estimate is larger than the sum of the groups because
insufficient data were available to determine a priority group for some
respondents; percent estimates will not sum to 100 because veterans
could indicate more than one type of insurance.

NOTE: Priority groups were determined by classifying the self-reported
data of all respondents according to VA health care enrollee criteria
and are not limited to actual VA enrollees.

Table 6-2. Percent distribution of veterans by type of insurance and age

  --------------------- ------------ ----------- ----------- ----------- ----------- ----------- -----------
                        Total        Less than   35-44 years 45-54 years 55-64 years 65-74 years 75 years or
                                     35 years                                                    older

  Medicare              39.3         1.1\*       3.6         6.2         8.0         95.5        96.6

  Medicare managed care 11.0         0.8\*       1.1         1.9         1.8         27.5        26.3
  or Medicare HMO                                                                                

  Medicare Part A for   2.4          0.0         0.5\*       0.6         0.7         6.3         4.7
  hospital care only                                                                             

  Medicare Part B for   1.0          0.0         0.2\*       0.2         0.2\*       2.2         2.7
  visits to doctor                                                                               
  offices only                                                                                   

  Both Medicare Part A  24.2         0.2\*       1.6         2.9         4.8         58.6        61.4
  and Part B                                                                                     

  Medigap or Medicare   18.0         0.4\*       0.5\*       0.5         1.7         43.0        51.3
  Supplement health                                                                              
  insurance plan                                                                                 

  Medicaid/Medi-Cal     3.5          1.3         1.6         2.1         1.7         7.3         5.4

  CHAMPUS or TRICARE    7.1          4.5         9.6         8.9         9.9         5.4         3.4

  Other                 3.5          2.3         3.5         3.7         3.5         4.0         3.4
  government-provided                                                                            
  health insurance or                                                                            
  health service plan                                                                            

  Private Non-HMO       37.2         36.7        37.1        37.9        43.4        34.3        32.8

  Private HMO           25.8         35.2        36.5        35.8        34.4        11.3        7.6

  No insurance coverage 10.0         22.1        16.0        15.5        11.6        1.0         1.0
  mentioned                                                                                      

  Unknown               0.4          0.8\*       0.5         0.7         0.2\*       0.1\*       0.2\*

  Number of veterans†   25,196,000   2,288,600   3,030,300   5,415,100   4,946,000   5,256,400   4,116,100
  --------------------- ------------ ----------- ----------- ----------- ----------- ----------- -----------

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred;
the total estimate is larger than the sum of the groups because some
veterans did not provide their age; percent estimates will not sum to
100 because veterans could indicate more than one type of insurance.

Table 6-3. Percent distribution of veterans by type of insurance and age
(under 65 and 65 or older)

  ----------------------------------------- ------------ ------------ -----------
                                            Total        Less than\   65 years\
                                                         65 years     or older

  Medicare                                  39.3         5.5          96.0

  Medicare managed care or Medicare HMO     11.0         1.5          27.0

  Medicare Part A for hospital care only    2.4          0.5          5.6

  Medicare Part B for visits to doctor      1.0          0.2          2.4
  offices only                                                        

  Both Medicare Part A and Part B           24.2         2.9          59.8

  Medigap or Medicare Supplement health     18.0         0.9          46.7
  insurance plan                                                      

  Medicaid/Medi-Cal                         3.5          1.7          6.5

  CHAMPUS or TRICARE                        7.1          8.7          4.5

  Other government-provided health          3.5          3.4          3.7
  insurance or health service plan                                    

  Private non-HMO                           37.2         39.3         33.6

  Private HMO                               25.8         35.4         9.7

  No insurance coverage mentioned           10.0         15.3         1.0

  Unknown                                   0.4          0.5          0.1\*

  Number of veterans†                       25,196,000   15,680,000   9,372,600
  ----------------------------------------- ------------ ------------ -----------

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred;
the total estimate is larger than the sum of the groups because some
veterans did not provide their age; percent estimates will not sum to
100 because veterans could indicate more than one type of health
insurance.

**Race, Ethnicity, and Health Insurance Coverage.** Table 6-4 reports
insurance coverage by race. A larger proportion of White veterans are
covered by Medicare, compared to veterans of other races. This is not
surprising, since White veterans are older as a group, compared to other
races. White veterans also more frequently report having some type of
private insurance than do veterans of other races, although this
difference is less striking. Asian veterans reported the highest
percentage of CHAMPUS or TRICARE coverage (17.9 percent), relative to
other veterans. Proportionately more Black, biracial American
Indian-White, American Indian, and Asian veterans did not mention any
insurance coverage (17.6 percent, 16.3 percent, 15.7 percent, and 14.7
percent, respectively) than did White veterans (8.6 percent).

Table 6-5 compares insurance coverage for Hispanic and non-Hispanic
veterans. The percentage of Hispanic veterans reporting Medicare
coverage is nearly half that of non-Hispanic veterans (23.2 percent vs.
40.0 percent, respectively). Slightly fewer Hispanic veterans reported
private non-HMO insurance coverage, relative to non-Hispanic veterans
(30.4 percent vs. 37.5 percent, respectively), but more Hispanic
veterans reported having private HMO coverage (30.1 percent of Hispanic
vs. 25.6 percent of non-Hispanic veterans). More Hispanic veterans did
not mention any insurance coverage, compared to non-Hispanic veterans
(19.0 percent vs. 9.6 percent, respectively).

Table 6-4. Percent distribution of veterans by type of insurance and
race

<table style="width:100%;">
<colgroup>
<col style="width: 16%" />
<col style="width: 9%" />
<col style="width: 7%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 9%" />
<col style="width: 5%" />
<col style="width: 10%" />
<col style="width: 7%" />
<col style="width: 9%" />
<col style="width: 0%" />
<col style="width: 6%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td></td>
<td colspan="6">One race</td>
<td colspan="2">Two or more races</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td>Total</td>
<td>Total<br />
one race</td>
<td>White</td>
<td>Black or<br />
African American</td>
<td>American Indian or Alaska Native</td>
<td>Asian</td>
<td>Native Hawaiian or Other Pacific Islander</td>
<td>Total<br />
two or<br />
more races</td>
<td colspan="2">American Indian or Alaska Native/White</td>
<td>Race unknown</td>
</tr>
<tr class="odd">
<td>Medicare</td>
<td>39.3</td>
<td>40.1</td>
<td>41.5</td>
<td>28.4</td>
<td>23.5</td>
<td>29.4</td>
<td>27.3*</td>
<td>29.0</td>
<td colspan="2">33.4</td>
<td>22.0</td>
</tr>
<tr class="even">
<td>Medicare managed care or Medicare HMO</td>
<td>11.0</td>
<td>11.2</td>
<td>11.3</td>
<td>10.0</td>
<td>7.7*</td>
<td>10.1</td>
<td>17.7*</td>
<td>8.6</td>
<td colspan="2">9.5</td>
<td>8.4</td>
</tr>
<tr class="odd">
<td>Medicare Part A for hospital care only</td>
<td>2.4</td>
<td>2.4</td>
<td>2.4</td>
<td>2.6</td>
<td>1.7*</td>
<td>5.3*</td>
<td>3.1*</td>
<td>3.0</td>
<td colspan="2">3.3</td>
<td>1.6*</td>
</tr>
<tr class="even">
<td>Medicare Part B for visits to doctor offices only</td>
<td>1.0</td>
<td>1.0</td>
<td>1.0</td>
<td>1.9</td>
<td>0.6*</td>
<td>0.9*</td>
<td>0.0</td>
<td>1.2*</td>
<td colspan="2">1.3*</td>
<td>0.5*</td>
</tr>
<tr class="odd">
<td>Both Medicare Part A<br />
and Part B</td>
<td>24.2</td>
<td>24.8</td>
<td>26.2</td>
<td>13.0</td>
<td>13.1</td>
<td>11.4*</td>
<td>6.5*</td>
<td>15.4</td>
<td colspan="2">18.5</td>
<td>10.8</td>
</tr>
<tr class="even">
<td>Medigap or Medicare Supplement health insurance plan</td>
<td>18.0</td>
<td>18.5</td>
<td>19.7</td>
<td>8.0</td>
<td>4.7</td>
<td>12.6</td>
<td>4.7*</td>
<td>8.4</td>
<td colspan="2">10.2</td>
<td>8.9</td>
</tr>
<tr class="odd">
<td>Medicaid/Medi-Cal</td>
<td>3.5</td>
<td>3.5</td>
<td>3.1</td>
<td>6.9</td>
<td>4.8*</td>
<td>5.0*</td>
<td>5.6*</td>
<td>3.4*</td>
<td colspan="2">2.6</td>
<td>2.9</td>
</tr>
<tr class="even">
<td>CHAMPUS or TRICARE</td>
<td>7.1</td>
<td>7.1</td>
<td>6.8</td>
<td>8.7</td>
<td>9.3</td>
<td>17.9</td>
<td>10.5*</td>
<td>9.4</td>
<td colspan="2">9.3</td>
<td>7.3</td>
</tr>
<tr class="odd">
<td>Other government-provided health insurance or health service
plan</td>
<td>3.5</td>
<td>3.4</td>
<td>3.3</td>
<td>4.0</td>
<td>15.4</td>
<td>9.2*</td>
<td>1.0*</td>
<td>8.0</td>
<td colspan="2">7.3</td>
<td>2.7</td>
</tr>
<tr class="even">
<td>Private Non-HMO</td>
<td>37.2</td>
<td>37.5</td>
<td>39.0</td>
<td>25.3</td>
<td>28.2</td>
<td>27.6</td>
<td>8.4*</td>
<td>32.9</td>
<td colspan="2">33.1</td>
<td>30.5</td>
</tr>
<tr class="odd">
<td>Private HMO</td>
<td>25.8</td>
<td>25.6</td>
<td>24.8</td>
<td>33.1</td>
<td>32.1</td>
<td>30.4</td>
<td>41.2*</td>
<td>26.8</td>
<td colspan="2">21.8</td>
<td>30.4</td>
</tr>
<tr class="even">
<td><p>Percent distribution of veterans by</p>
<p>No insurance coverage mentioned</p></td>
<td>10.0</td>
<td>9.5</td>
<td>8.6</td>
<td>17.6</td>
<td>15.7</td>
<td>14.7</td>
<td>20.3*</td>
<td>15.5</td>
<td colspan="2">16.3</td>
<td>18.5</td>
</tr>
<tr class="odd">
<td>Unknown</td>
<td>0.4</td>
<td>0.3</td>
<td>0.3</td>
<td>0.5*</td>
<td>1.3*</td>
<td>1.4*</td>
<td>0.0*</td>
<td>1.1*</td>
<td colspan="2">1.3*</td>
<td>1.2*</td>
</tr>
<tr class="even">
<td>Number of veterans†</td>
<td>25,196,000</td>
<td>23,857,100</td>
<td>21,370,900</td>
<td>2,216,600</td>
<td>159,900</td>
<td>73,200</td>
<td>36,500</td>
<td>557,500</td>
<td colspan="2">360,800</td>
<td>781,400</td>
</tr>
</tbody>
</table>

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred;
percent estimates will not sum to 100 because veterans could indicate
more than one type of health insurance.

Table 6-5. Percent distribution of veterans by type of insurance and
ethnicity

  ---------------------------------- ------------ ------------ -------------
                                     Total        Spanish,     Not Spanish,
                                                  Hispanic, or Hispanic, or
                                                  Latino       Latino

  Medicare                           39.3         23.2         40.0

  Medicare managed care or Medicare  11.0         9.7          11.1
  HMO                                                          

  Medicare Part A for hospital care  2.4          1.6\*        2.5
  only                                                         

  Medicare Part B for visits to      1.0          0.3\*        1.1
  doctor offices only                                          

  Both Medicare Part A and Part B    24.2         10.7         24.8

  Medigap or Medicare Supplement     18.0         7.3          18.4
  health insurance plan                                        

  Medicaid/Medi-Cal                  3.5          3.6          3.5

  CHAMPUS or TRICARE                 7.1          5.9          7.2

  Other government-provided health   3.5          2.3          3.6
  insurance or health service plan                             

  Private Non-HMO                    37.2         30.4         37.5

  Private HMO                        25.8         30.1         25.6

  No insurance coverage mentioned    10.0         19.0         9.6

  Unknown                            0.4          1.1\*        0.4

  Number of veterans†                25,196,000   1,122,200    23,990,200
  ---------------------------------- ------------ ------------ -------------

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred;
the total estimate is larger than the sum of the groups because some
veterans did not provide a category of Ethnicity; percent estimates will
not sum to 100 because veterans could indicate more than one type of
health insurance.

# 6.2 Health Care Received in the Past Year

Veterans were asked to indicate types of health care they had received
in the past 12 months. Veterans could mention more than one type of
health care received in the previous 12 months, so columns may not sum
to 100 percent. As Table 6-6, displays, the most frequently mentioned
type of health care was for prescriptions; more than three in four
veterans (76.7 percent) received this type of care in the past 12
months. Also frequently mentioned were outpatient care (74.1 percent),
prostheses (including hearing aids and eyeglasses) (24.6 percent), and
emergency room care (23.4 percent).

**Health Care Priority Group and Health Care Received in the Past
Year.** Table 6-6 also displays results that compare health care
priority groups in the kinds of medical treatment they received in the
past 12 months. Tables include all veterans who reported their medical
treatment in the past year, not just veterans enrolled in the national
health care enrollment system (see Chapter 5 introduction for further
explanation). Prescription services are the most commonly mentioned type
across all priority groups. Outpatient care ranges from a low of 69.4
percent for Priority 5 veterans to a high of 86.6 percent for Priority 1
veterans. The incidence of prescription services ranges from 74.2
percent for Priority 7 to 96.4 percent for Priority 4.

The proportion of veterans reporting emergency room and inpatient care
varies considerably by priority group. The highest reported rates of
emergency room and inpatient care are for veterans in Priority 4 (61.2
percent and 59.6 percent, respectively). Veterans in Priority 4 also
report the highest incidence of in-home health care (26.6 percent) and
prosthetic services (39.6 percent). Since these veterans are classified
into Priority 4 because they are permanently house-bound or
catastrophically disabled, these findings are not surprising.

The lowest percentage of emergency room care and inpatient care is found
among veterans in Priority 7 (19.0 percent and 11.7 percent). Veterans
in Priority 6 also report relatively low incidences of emergency room
and inpatient care.

**Age and Heath Care Received in the Past Year.** Table 6-7 compares
health care received in the past 12 months by age group of veterans.
Some types of health care varied consistently by age. The proportion of
veterans reporting outpatient and inpatient services, prescription
services, in-home health care, and prostheses increased across the age
groups. For example, only 7.2 percent of veterans under 35 years of age
reported inpatient care in the past 12 months while 24.1 percent of
veterans 75 years or older reported inpatient care. Conversely,
psychiatric treatment or counseling is reported by a smaller percentage
of older veterans.

Table 6-8 displays age comparisons of health care received in the past
12 months for two groups of veterans, those under age 65 and those age
65 or older. Across all health care types, proportionately more older
veterans reported receiving such care, compared to younger veterans. The
only exceptions to this are for psychiatric treatment or counseling and
treatment for environmental hazard.

Table 6-6. Percent distribution of veterans by type of care and health
care priority group

  ----------------- ------------ ---------- ---------- ----------- ---------- ----------- ----------- ------------
                    Total        Priority 1 Priority 2 Priority 3  Priority 4 Priority 5  Priority 6  Priority 7

  Emergency room    23.4         43.9       33.6       29.2        61.2       30.0        21.8        19.0

  Outpatient        74.1         86.6       86.1       83.5        81.8       69.4        76.3        73.4

  Inpatient         14.3         28.5       20.9       16.1        59.6       19.2        12.0        11.7

  Prescriptions     76.7         95.1       91.7       86.4        96.4       77.3        75.6        74.2

  Treatment for     1.6          12.7       7.0        3.2         11.5\*     1.6         4.3         0.0
  environmental                                                                                       
  hazard                                                                                              

  Psychiatric       6.7          32.9       14.1       9.5         10.5       9.0         7.6         3.7
  treatment/                                                                                          
  counseling                                                                                          

  In-home health    3.8          9.5        4.8        5.1         26.6       6.1         2.7         2.6
  care                                                                                                

  Prostheses        24.6         51.4       37.5       32.6        39.6       22.3        26.1        22.4

  Number of         25,196,000   719,400    580,900    1,441,600   29,000     5,326,400   2,828,300   14,125,600
  veterans†                                                                                           
  ----------------- ------------ ---------- ---------- ----------- ---------- ----------- ----------- ------------

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred;
the total estimate is larger than the sum of the groups because
insufficient data were available to determine a priority group for some
respondents; percent estimates will not sum to 100 because veterans
could indicate more than one type of health care.

NOTE: Priority groups were determined by classifying the self-reported
data of all respondents according to VA health care enrollee criteria
and are not limited to actual VA enrollees.

Table 6-7. Percent distribution of veterans by type of care and age

+--------------------+------+------+-----+-----+------+------+------+
|                    | T    | Less | 35  | 45  | 5    | 6    | 75   |
|                    | otal | than | -44 | -54 | 5-64 | 5-74 | y    |
|                    |      |      |     |     |      |      | ears |
|                    |      | 35   | ye  | ye  | y    | y    |      |
|                    |      | y    | ars | ars | ears | ears | or   |
|                    |      | ears |     |     |      |      | o    |
|                    |      |      |     |     |      |      | lder |
+--------------------+------+------+-----+-----+------+------+------+
| Emergency room     | 23.4 | 23.0 | 2   | 2   | 18.8 | 22.3 | 29.1 |
|                    |      |      | 5.9 | 3.4 |      |      |      |
+--------------------+------+------+-----+-----+------+------+------+
| Outpatient         | 74.1 | 59.7 | 6   | 7   | 76.6 | 80.4 | 79.4 |
|                    |      |      | 8.1 | 1.3 |      |      |      |
+--------------------+------+------+-----+-----+------+------+------+
| Inpatient          | 14.3 | 7.2  | 7.9 | 1   | 12.8 | 18.5 | 24.1 |
|                    |      |      |     | 0.8 |      |      |      |
+--------------------+------+------+-----+-----+------+------+------+
| Prescriptions      | 76.7 | 57.4 | 6   | 7   | 79.2 | 84.0 | 87.0 |
|                    |      |      | 6.3 | 3.7 |      |      |      |
+--------------------+------+------+-----+-----+------+------+------+
| Treatment for      | 1.6  | 0    | 1.2 | 2.7 | 1.8  | 1.2  | 1.0  |
| environmental      |      | .9\* |     |     |      |      |      |
| hazard             |      |      |     |     |      |      |      |
+--------------------+------+------+-----+-----+------+------+------+
| Psychiatric        | 6.7  | 8.9  | 1   | 1   | 5.8  | 2.7  | 2.5  |
| tr                 |      |      | 0.6 | 1.4 |      |      |      |
| eatment/counseling |      |      |     |     |      |      |      |
+--------------------+------+------+-----+-----+------+------+------+
| In-home health     | 3.8  | 1    | 1.7 | 2.4 | 2.3  | 4.9  | 8.9  |
| care               |      | .1\* |     |     |      |      |      |
+--------------------+------+------+-----+-----+------+------+------+
| Prostheses         | 24.6 | 13.8 | 1   | 2   | 26.4 | 26.9 | 30.0 |
|                    |      |      | 6.8 | 6.0 |      |      |      |
+--------------------+------+------+-----+-----+------+------+------+
| Number of          | 25   | 2    | 3,0 | 5,4 | 4    | 5    | 4    |
| veterans†          | ,196 | ,288 | 30, | 15, | ,946 | ,256 | ,116 |
|                    | ,000 | ,600 | 300 | 100 | ,000 | ,400 | ,100 |
+--------------------+------+------+-----+-----+------+------+------+

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred;
the total estimate is larger than the sum of the groups because some
veterans did not provide their age; percent estimates will not sum to
100 because veterans could indicate more than one type of health care.

Table 6-8. Percent distribution of veterans by type of care and age
(under 65 and 65 or older)

  --------------------------- -------------- -------------- --------------
                              Total          Less than 65   65 years or
                                             years          older

  Emergency room              23.4           22.4           25.3

  Outpatient                  74.1           70.6           79.9

  Inpatient                   14.3           10.3           21.0

  Prescriptions               76.7           71.7           85.3

  Treatment for environmental 1.6            1.9            1.1
  hazard                                                    

  Psychiatric                 6.7            9.1            2.7
  treatment/counseling                                      

  In-home health care         3.8            2.1            6.7

  Prostheses                  24.6           22.6           28.3

  Number of veterans†         25,196,000     15,680,000     9,372,600
  --------------------------- -------------- -------------- --------------

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred;
the total estimate is larger than the sum of the groups because some
veterans did not provide their age; percent estimates will not sum to
100 because veterans could indicate more than one type of health care.

**Race, Ethnicity, and Health Care Received in the Past Year.**
Differences in type of health care received were found among veterans of
different races and ethnicity, as shown in Tables 6-9 and 6-10. Compared
to all other races, White veterans had the highest percentage of
outpatient care and a high percentage of prosthetic use. Black veterans
reported a high percentage of emergency room use, compared to others.
American Indian veterans had the highest percentage of inpatient
services use and a high proportion of psychiatric treatment or
counseling services use. Biracial American Indian-White veterans
reported high percentages using outpatient services and the highest
percentage of emergency room services, prescription services,
psychiatric treatment or counseling and prosthetic use of all racial
groups. Compared to non-Hispanic veterans, proportionately fewer
Hispanic veterans reported receiving all types of health care, except
emergency room, treatment for environmental hazard, psychiatric, and
in-home health care. For these four, slightly more Hispanic veterans
reported their use, relative to non-Hispanic veterans.

Table 6-9. Percent distribution of veterans by type of care and race

  --------------- ------------ ------------ ------------ ----------- ---------- -------- ---------- --------- ---------- ---------
                               One race                                                             Two or               
                                                                                                    more                 
                                                                                                    races                

                  Total        Total\       White        Black or\   American   Asian    Native     Total\    American   Race
                               one race                  African     Indian or           Hawaiian   two or\   Indian or  unknown
                                                         American    Alaska              or Other   more      Alaska     
                                                                     Native              Pacific    races     Native/    
                                                                                         Islander             White      

  Emergency room  23.4         23.0         22.3         30.2        25.7       17.4     27.0\*     32.4      33.3       28.1

  Outpatient      74.1         74.4         75.2         68.3        63.2       65.1     61.2\*     72.1      73.9       64.4

  Inpatient       14.3         14.4         14.3         15.7        18.5       8.7\*    8.9\*      14.1      15.7       10.1

  Prescriptions   76.7         77.1         77.4         75.2        70.3       65.4     60.0\*     76.7      81.4       65.7

  Treatment for   1.6          1.6          1.4          2.6         3.4\*      4.3\*    1.6\*      3.3       3.2        1.5\*
  environmental                                                                                                          
  hazard                                                                                                                 

  Psychiatric     6.7          6.5          6.2          9.3         11.9       2.6\*    5.7\*      13.0      14.4       8.1
  treatment/                                                                                                             
  counseling                                                                                                             

  In-home health  3.8          3.7          3.6          4.9         3.7\*      0.5\*    12.8\*     5.3       4.7        3.0
  care                                                                                                                   

  Prostheses      24.6         24.8         25.2         21.0        22.9       19.8     19.3\*     24.0      26.4       20.4

  Number of       25,196,000   23,857,100   21,370,900   2,216,600   159,900    73,200   36,500     557,500   360,800    781,400
  veterans†                                                                                                              
  --------------- ------------ ------------ ------------ ----------- ---------- -------- ---------- --------- ---------- ---------

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred;
percent estimates will not sum to 100 because veterans could indicate
more than one type of health care.

Table 6-10. Percent distribution of veterans by type of care and
ethnicity

  ----------------------------- ------------ -------------- ----------------
                                Total        Spanish,       Not Spanish,
                                             Hispanic, or   Hispanic, or
                                             Latino         Latino

  Emergency room                23.4         25.7           23.3

  Outpatient                    74.1         62.9           74.6

  Inpatient                     14.3         9.6            14.5

  Prescriptions                 76.7         67.7           77.1

  Treatment for environmental   1.6          2.1            1.6
  hazard                                                    

  Psychiatric                   6.7          7.7            6.6
  treatment/counseling                                      

  In-home health care           3.8          3.9            3.8

  Prostheses                    24.6         18.4           24.9

  Number of veterans†           25,196,000   1,122,200      23,990,200
  ----------------------------- ------------ -------------- ----------------

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred;
the total estimate is larger than the sum of the groups because some
veterans did not provide a category of Ethnicity; percent estimates will
not sum to 100 because veterans could indicate more than one type of
health care.

# 6.3 Sources of Health Care

Veterans were asked to indicate whether VA provided the health care they
received in the past 12 months. A classification of health care source
was constructed from survey responses as VA care only, non-VA care only,
and use of both VA and non-VA. As Table 6-11 displays, more than
three-quarters of veterans (76.6 percent) used only non-VA health care
in the past year. Seven point four percent used VA only, while 16.0
percent used both VA and non-VA health care.

**Health Care Priority Group and Source of Care.** Table 6-11 also
compares source of health care received in the past year by priority
group. Usage patterns vary considerably by priority group. For example,
well over half of the veterans in Priority Groups 1, 2, and 4 received
their care either exclusively from VA or from VA plus non-VA sources
(82.0, 57.1, and 79.1 percent, respectively). By contrast, over 80
percent of veterans in Priority 6 and 7 report only receiving non-VA
care (86.3 and 88.1 percent, respectively).

**Age and Source of Care.** Table 6-12 compares type of veteran health
care received in the past 12 months by age group of veterans. Results
show that regardless of age, the proportion of veterans who use VA
health care only is very low, between 5.6 and 8.4 percent. The
proportion of veterans using both VA and non-VA sources increases across
age groups, except among the 55-64 age group.

Table 6-11. Percent distribution of veterans by source of care and
health care priority group

  ----------------- ------------ ---------- ---------- ----------- ---------- ----------- ----------- ------------
                    Total        Priority 1 Priority 2 Priority 3  Priority 4 Priority 5  Priority 6  Priority 7

  Use of VA health  7.4          30.4       18.6       12.0        33.1       15.5        3.4         2.6
  care only                                                                                           

  Use of non-VA     76.6         18.0       42.9       57.8        20.9\*     60.8        86.3        88.1
  health care only                                                                                    

  Use of both VA    16.0         51.6       38.5       30.2        46.0       23.7        10.3        9.3
  and non-VA health                                                                                   
  care                                                                                                

  Total             100.0        100.0      100.0      100.0       100.0      100.0       100.0       100.0

  Number of         22,223,200   707,100    557,400    1,353,900   28,200     4,695,600   2,453,800   12,317,500
  veterans†                                                                                           
  ----------------- ------------ ---------- ---------- ----------- ---------- ----------- ----------- ------------

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred;
the total estimate is larger than the sum of the groups because
insufficient data were available to determine a priority group for some
respondents; percent estimates will not sum to 100 because veterans
could indicate more than one type of health care.

NOTE: Priority groups were determined by classifying the self-reported
data of all respondents according to VA health care enrollee criteria
and are not limited to actual VA enrollees.

Table 6-12. Percent distribution of veterans by source of care and age

+---------------+-------+------+------+------+------+------+------+
|               | Total | Less | 3    | 4    | 5    | 6    | 75   |
|               |       | than | 5-44 | 5-54 | 5-64 | 5-74 | y    |
|               |       |      |      |      |      |      | ears |
|               |       | 35   | y    | y    | y    | y    |      |
|               |       | y    | ears | ears | ears | ears | or   |
|               |       | ears |      |      |      |      | o    |
|               |       |      |      |      |      |      | lder |
+---------------+-------+------+------+------+------+------+------+
| Use of VA     | 7.4   | 6.0  | 5.6  | 8.4  | 7.6  | 8.1  | 6.9  |
| health care   |       |      |      |      |      |      |      |
| only          |       |      |      |      |      |      |      |
+---------------+-------+------+------+------+------+------+------+
| Use of non-VA | 76.6  | 85.3 | 82.6 | 77.2 | 79.7 | 73.0 | 69.2 |
| health care   |       |      |      |      |      |      |      |
| only          |       |      |      |      |      |      |      |
+---------------+-------+------+------+------+------+------+------+
| Use of both   | 16.0  | 8.7  | 11.8 | 14.4 | 12.7 | 18.9 | 23.9 |
| VA and non-VA |       |      |      |      |      |      |      |
| health care   |       |      |      |      |      |      |      |
+---------------+-------+------+------+------+------+------+------+
| Total         | 100.0 | 1    | 1    | 1    | 1    | 1    | 1    |
|               |       | 00.0 | 00.0 | 00.0 | 00.0 | 00.0 | 00.0 |
+---------------+-------+------+------+------+------+------+------+
| Number of     | 22,22 | 1    | 2    | 4    | 4    | 4    | 3    |
| veterans†     | 3,200 | ,755 | ,452 | ,638 | ,410 | ,919 | ,933 |
|               |       | ,000 | ,900 | ,800 | ,600 | ,800 | ,500 |
+---------------+-------+------+------+------+------+------+------+

† Estimates of number of veterans are rounded to the nearest hundred;
the total estimate is larger than the sum of the groups because some
veterans did not provide their age.

NOTE: This table only includes responses of those who indicated they
used some sort of health care in the last 12 months.

To highlight young-old age differences, Table 6-13 compares source of
health care for younger and older veterans (younger than 65 years and 65
years of age or older). When combined into two groups, the difference
between younger and older veterans appears to be predominately in terms
of using both VA and non-VA care and non-VA care exclusively. Older
veterans less frequently report exclusive use of non-VA care.

Table 6-13. Percent distribution of veterans by source of care and age
(under 65 and 65 or older)

+---------------------------------+-----------+-----------+-----------+
|                                 | Total     | Less than | 65 years  |
|                                 |           |           |           |
|                                 |           | 65 years  | or older  |
+---------------------------------+-----------+-----------+-----------+
| Use of VA health care only      | 7.4       | 7.3       | 7.6       |
+---------------------------------+-----------+-----------+-----------+
| Use of non-VA health care only  | 76.6      | 80.1      | 71.3      |
+---------------------------------+-----------+-----------+-----------+
| Use of both VA and non-VA       | 16.0      | 12.6      | 21.1      |
| health care                     |           |           |           |
+---------------------------------+-----------+-----------+-----------+
| Total                           | 100.0     | 100.0     | 100.0     |
+---------------------------------+-----------+-----------+-----------+
| Number of veterans†             | 2         | 1         | 8,853,300 |
|                                 | 2,223,200 | 3,257,300 |           |
+---------------------------------+-----------+-----------+-----------+

† Estimates of number of veterans are rounded to the nearest hundred;
the total estimate is larger than the sum of the groups because some
veterans did not provide their age.

NOTE: This table only includes responses of those who indicated they
used some sort of health care in the last 12 months.

**Race, Ethnicity, and Source of Care.** Table 6-14 compares source of
health care for veterans of different races. White veterans have the
smallest proportion using exclusively VA health care (6.4 percent) and
the largest proportion using exclusively non-VA health care (78.3
percent). More black veterans use VA health care only (13.9 percent),
relative to all other races, followed by biracial American Indian-White
veterans (10.7 percent).

Table 6-14. Percent distribution of veterans by source of care and race

  ------------ ------------ ------------ ------------ ----------- ---------- -------- ---------- --------- --------- -------------- ---------
                            One race                                                             Two or                             
                                                                                                 more                               
                                                                                                 races                              

               Total        Total\       White        Black or\   American   Asian    Native     Total\              American       Race
                            one race                  African     Indian or           Hawaiian   two or\             Indian or      unknown
                                                      American    Alaska              or Other   more                Alaska         
                                                                  Native              Pacific    races               Native/White   
                                                                                      Islander                                      

  Use of VA    7.4          7.1          6.4          13.9        9.7        9.0\*    10.6\*     12.6      10.7                     12.0
  health care                                                                                                                       
  only                                                                                                                              

  Use of       76.6         77.0         78.3         64.3        70.5       71.9     72.4\*     65.2      67.1                     73.2
  non-VA                                                                                                                            
  health care                                                                                                                       
  only                                                                                                                              

  Use of both  16.0         15.9         15.3         21.8        19.8       19.1     17.0\*     22.2      22.2                     14.8
  VA and                                                                                                                            
  non-VA                                                                                                                            
  health care                                                                                                                       

  Total        100.0        100.0        100.0        100.0       100.0      100.0    100.0      100.0     100.0                    100.0

  Number of    22,223,200   21,112,000   18,987,700   1,910,600   131,100    56,400   26,200     477,200   316,600                  634,000
  veterans†                                                                                                                         
  ------------ ------------ ------------ ------------ ----------- ---------- -------- ---------- --------- --------- -------------- ---------

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred.

NOTE: This table only includes responses of those who indicated they
used some sort of health care in the last 12 months.

Table 6-15 displays a comparison of Hispanic and non-Hispanic veterans'
sources of health care. The largest contrast between ethnicities is in
the use of VA health care only, which about one in 8 Hispanic veterans
use (12.0 percent), compared to about one in 14 non-Hispanic veterans
(7.2 percent). Ethnic differences are less striking in use of both and
of non-VA health care only.

Table 6-15. Percent distribution of veterans by source of care and
ethnicity

  --------------------------------- ------------ ------------- --------------
                                    Total        Spanish,      Not Spanish,
                                                 Hispanic, or  Hispanic, or
                                                 Latino        Latino

  Use of VA health care only        7.4          12.0          7.2

  Use of non-VA health care only    76.6         73.4          76.8

  Use of both VA and non-VA health  16.0         14.6          16.0
  care                                                         

  Total                             100.0        100.0         100.0

  Number of veterans†               22,223,200   888,900       21,263,700
  --------------------------------- ------------ ------------- --------------

\* Low precision and/or sample size for the denominator between 30 and
59.

† Estimates of number of veterans are rounded to the nearest hundred;
the total estimate is larger than the sum of the groups because some
veterans did not provide a category of Ethnicity.

NOTE: This table only includes responses of those who indicated they
used some sort of health care in the last 12 months.

# 6.4 Reasons for Not Using VA Health Care

Veterans who did not use VA health care in the past year were asked to
give the reasons why they did not use it. Table 6-16 provides the
reasons veterans gave for not using VA health care in the past year. The
most frequently cited reason for not using VA health care in the past
year was that the veteran has other sources for health care; about 40
percent of non-users gave this reason. About one out of five non-users
said they did not require health care in the past year (20.9 percent),
did not believe they were eligible for health care benefits (20.1
percent), or perceived VA health care as inconvenient (18.2 percent).
About 17 percent said they were not aware of VA health care benefits
(16.6 percent). Only one in 25 non-users said they did not think VA
health care would be as good as that available elsewhere (4.0 percent),
while less than two in 100 non-users mentioned having been treated
rudely by VA health care providers (1.4 percent) as reasons for not
using VA health care.

Veterans who reported that they had never used VA health care were also
asked to give the reasons why they had not. Table 6-17 displays these
reasons. Whether the time frame is the past year or ever, there is
considerable overlap in the most common reasons cited for not using VA
health care with the most common being the use of another source for
health care. Almost one out of three non-users said they had other
sources for health care (31.8 percent), while nearly one in four said
they did not need health care (23.7 percent). About one in five veterans
said they were not aware of VA health care benefits (21.6 percent) or
they did not believe they were eligible for VA health care (20.4
percent). The least commonly mentioned reasons were: did not think VA
health care would be as good as that available elsewhere (3.1 percent);
too much trouble or red tape in the application process (3.0 percent);
and did not know how to apply (2.3 percent).

Table 6-16. Percent distribution of veterans by reasons veterans did not
use VA health care in past 12 months

  --------------------------------------------------------- -------------
                                                            Total

  Uses other sources for health care                        40.2

  Did not need any care                                     20.9

  Did not believe self entitled or eligible for health care 20.1
  benefits                                                  

  VA care is inconvenient                                   18.2

  Not aware of the VA health care benefits                  16.6

  Other                                                     10.7

  Did not need or want assistance from the VA               7.8

  Never considered getting any health care from the VA      5.4

  Didn't think VA health care would be as good as that      4.0
  available elsewhere                                       

  Applying for health care benefits too much trouble or red 3.5
  tape                                                      

  Did not know how to apply for health care benefits        2.1

  Treated rudely in past                                    1.4

  Unknown                                                   0.4

  Number of veterans†                                       19,978,000
  --------------------------------------------------------- -------------

† Estimate of number of veterans is rounded to the nearest hundred;.
percent estimates will not add to 100 because veterans could indicate
more than one reason;

NOTE: This table only includes responses of those who indicated they had
not used VA health care during the past 12 months

Table 6-17. Percent distribution of veterans by reasons veterans never
used VA health care

  ----------------------------------------------------------- ------------
                                                              Total

  Uses other sources for health care                          31.8

  Did not need any care                                       23.7

  Not aware of the VA health care benefits                    21.6

  Did not believe self entitled or eligible for health care   20.4
  benefits                                                    

  VA care is inconvenient                                     13.3

  Other                                                       9.5

  Did not need or want assistance from the VA                 8.0

  Never considered getting any health care from the VA        5.1

  Didn't think VA health care would be as good as that        3.1
  available elsewhere                                         

  Applying for health care benefits too much trouble or red   3.0
  tape                                                        

  Did not know how to apply for health care benefits          2.3

  Number of veterans†                                         16,396,700
  ----------------------------------------------------------- ------------

† Estimate of number of veterans is rounded to the nearest hundred;
percent estimates will not sum to more than 100 because veterans could
indicate more than one reason.

NOTE: This table only includes responses of those who indicated they had
never used VA health care.

[^1]: In a small number of cases, veterans did not report coverage by
    one of the major modes of coverage such as private insurance but did
    report coverage by one of the major mode subtypes of coverage such
    as a private HMO.