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Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

by Christine Eibner, Heather Krull, Kristine M. Brown, Matthew Cefalu, Andrew W. Mulcahy, Michael S. Pollard, Kanaka Shetty, David M. Adamson, Ernesto F. L. Amaral, Philip Armour, et al.

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Research Questions

  1. What are the demographic characteristics of the U.S. veteran population, and how are they projected to shift in the next decade?
  2. What are the current health care needs of the veteran population, including both VA patients and non-VA patients, and how do these needs compare with those of the non-veteran population?
  3. How will the needs of veterans in general and the VA patient population specifically evolve over time, given current policies?
  4. To what extent do veterans rely on VA for their health care?
  5. How might external forces or changes to VA policy affect the characteristics of veterans, their eligibility to use VA health care, and their health care needs over time?

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next decade, and the demographic mix and geographic locations of these veterans will change. While the number of veterans using VA health care has increased over time, demand will level off in the coming years. Veterans have more favorable economic circumstances than non-veterans, but they are also older and more likely to be diagnosed with many health conditions. Not all veterans are eligible for or use VA health care. Whether and to what extent an eligible veteran uses VA health care depends on a number of factors, including access to other sources of health care. Veterans who rely on VA health care are older and less healthy than veterans who do not, and the prevalence of costly conditions in this population is projected to increase. Potential changes to VA policy and the context for VA health care, including effects of the Affordable Care Act, could affect demand. Analysis of a range of data sources provided insight into how the veteran population is likely to change in the next decade.

Key Findings

Veterans Are Better Off Than Non-Veterans, but VA Patients Are Older and Sicker Than the Veteran Population Overall

  • Veterans are older, have higher levels of education, and are less likely to be unemployed and live below the poverty line than non-veterans. Homelessness among veterans is also declining.
  • Veterans have a higher prevalence of many common heath conditions than non-veterans. VA patients are older and less healthy than veterans who do not use VA health care, and the prevalence of many health conditions is expected to increase among VA patients over the next decade.

The Veteran and VA Patient Populations Will Shift in the Next Decade

  • The veteran population is projected to decrease by 19 percent over the next ten years, barring a major policy change or large-scale conflict. The number of veterans who rely on VA health care is expected to increase over the next five years and then level off after that period.
  • The geographic distribution of veterans will change, with more veterans concentrated in urban areas. There will also be modest changes in the demographics of the veteran population.

VA Faces a Number of Challenges in Predicting Veterans' Health Care Needs

  • Most veterans who are eligible for VA health care have other sources of health coverage and rely on VA to meet only some of their health care needs. Predicting reliance on VA health care is difficult due to limitations in available data on veterans' health care use.
  • Significant policy and eligibility changes and economic trends could affect the number of veterans who rely on VA health care.

Recommendations

  • VA should prepare for a changing veteran population. The number of veterans and the size of the VA patient population will decrease over time, requiring decisions about how the VA health care system can best meet the needs of veterans in the future.
  • VA should improve tracking of some veteran populations. Little is currently known about the utilization patterns and health care needs of new veterans, in particular.
  • VA should anticipate shifts in the geographical distribution of veterans and align its facilities and services to meet these needs.
  • VA should improve its processes for collecting data on veterans' health care utilization. Data on the sources of health care used by its patients, their diagnoses and treatments, and who pays for the services will help VA better understand veterans' health care needs and the extent to which they rely on VA.
  • VA's demand projections should incorporate data on military separations and the health care needs of current service members. VA should have access to health care data on currently serving personnel to help it prepare for the new generation of veterans.
  • VA should develop methods and models to test proposed policy changes and economic and demographic factors affecting veterans' health care needs.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Conceptual Framework

  • Chapter Three

    Current and Future Demographics of the Veteran Population

  • Chapter Four

    Enrollment in and Reliance on the VA Health Care System

  • Chapter Five

    Health Care Needs of the Veteran Population

  • Chapter Six

    Scenario Development and Evaluation

  • Chapter Seven

    Conclusions and Recommendations

  • Appendix A

    Current and Future Demographic Trends in the Veteran Population

  • Appendix B

    Enrollment in and Reliance on the VA Health Care System

  • Appendix C

    Health Care Needs of the Veteran Population

  • Appendix D

    Scenario Development and Evaluation

The research described in this report was sponsored by the U.S. Department of Veterans Affairs and conducted by RAND Health, a division of the RAND Corporation.

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