Ann Hendricks

VHA enrollees' health care coverage and use of care.

The authors examined health care coverage for Veterans Health Administration (VHA) enrollees and how their reliance on VHA care varies by coverage, using the largest and most detailed survey of veterans using VHA services ever conducted. The results showed that a majority of veterans who use VHA services have alternative health care coverage and that most of them use both VHA and non-VHA health care. The findings have important implications for quality of care and coordination of care.

Costs of Home Versus Inpatient Treatment for Fever and Neutropenia: Analysis of a Multicenter Randomized Trial

PURPOSEnFor patients with cancer who have febrile neutropenia, relative costs of home versus hospital treatment, including unreimbursed costs borne by patients and families, are poorly characterized. We estimated costs from a randomized trial of patients with low-risk febrile neutropenia for whom outpatient care was feasible, comparing inpatient treatment with discharge to home care after inpatient observation.nnnMETHODSnWe collected direct medical and self-reported indirect costs for 57 inpatient and 35 outpatient treatment episodes of patients enrolled in a randomized trial from 1996 through 2000. Charges from hospital bills were converted to costs using Medicare cost-to-charge ratios. Patients kept daily logs of out-of-pocket payments and time spent by informal caregivers providing care. Dollar amounts were standardized to June 2008.nnnRESULTSnMean total charges for the hospital arm were 49% higher than for the home treatment arm (

Value for Taxpayers’ Dollars: What VA Care Would Cost at Medicare Prices

16,341 v

Do individuals with substance abuse diagnoses incur higher charges than individuals with other chronic conditions

10,977; P < .01). Mean estimated total costs for the hospital arm were 30% higher (

Private sector coverage of people with dual diagnoses.

10,143 v

VA-Medicare Dual Beneficiaries’ Enrollment in Medicare HMOs: Access to VA, Availability of HMOs, and Favorable Selection

7,830; P < .01). Inspection of sparse available data suggests that payments made were similar by treatment arm. Inpatients and their caregivers spent more out of pocket than their outpatient counterparts (mean,

Using Health Insurance Claims Data to Analyze Substance Abuse Charges and Utilization

201 v

Estimating private sector values for VA health care: an overview.

74; P < .01). Informal caregivers for both treatment arms reported similar time caring and lost from work.nnnCONCLUSIONnHome intravenous antibiotic treatment was less costly than continued inpatient care for carefully selected patients with cancer having febrile neutropenia without significantly increased indirect costs or caregiver burden.

Evaluating VA patient-level expenditures: Decision Support System estimates and Medicare rates

Critics charge that Veterans Health Administration (VA) medical centers are inefficient and the cost of veteran health care would be reduced if VApurchased care for its patients directly from private-sector providers. This analysis compares VAmedical care expenditures with estimates of total payments under a hypothetical Medicare fee-for-service payment system reimbursing providers for the same counts of each service VA medical centers provided in fiscal 1999. At six study sites, hypothetical payments were more than 20 percent greater than actual budgets. Nationally, this represented more than

What would VA nursing home care cost? Methods for estimating private sector payments.

3 billion in 1999 and more than