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Open Access Research article

The relationship between local area labor market conditions and the use of Veterans Affairs health services

Edwin S Wong12* and Chuan-Fen Liu12

Author Affiliations

1 Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA

2 Department of Health Services, School of Public Health and Community Medicine, University of Washington, Box 357660, Seattle, WA 98195, USA

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BMC Health Services Research 2013, 13:96  doi:10.1186/1472-6963-13-96

Published: 13 March 2013

Abstract

Background

In the U.S., economic conditions are intertwined with labor market decisions, access to health care, health care utilization and health outcomes. The Veterans Affairs (VA) health care system has served as a safety net provider by supplying free or reduced cost care to qualifying veterans. This study examines whether local area labor market conditions, measured using county-level unemployment rates, influence whether veterans obtain health care from the VA.

Methods

We used survey data from the Behavioral Risk Factor Surveillance System in years 2000, 2003 and 2004 to construct a random sample of 73,964 respondents self-identified as veterans. VA health service utilization was defined as whether veterans received all, some or no care from the VA. Hierarchical ordered logistic regression was used to address unobserved state and county random effects while adjusting for individual characteristics. Local area labor market conditions were defined as the average 12-month unemployment rate in veterans’ county of residence.

Results

The mean unemployment rate for veterans receiving all, some and no care was 5.56%, 5.37% and 5.24%, respectively. After covariate adjustment, a one percentage point increase in the unemployment rate in a veteran’s county of residence was associated with an increase in the probability of receiving all care (0.34%, p-value = 0.056) or some care (0.29%, p-value = 0.023) from the VA.

Conclusions

Our findings suggest that the important role of the VA in providing health care services to veterans is magnified in locations with high unemployment.

Keywords:
Health services; Utilization; Veterans; Socioeconomic factors