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The Veterans Health Administration (VHA) has historically served a disproportionately male patient population with lower income and greater rates of mental illness than non-VHA populations. The generalizability of research based on VHA enrollees is unknown because the overlap between VHA and non-VHA populations has never been empirically examined. This study used 2013 National Health Interview Survey data to examine the extent to which VHA enrollees had similar demographic and health characteristics as individuals with Medicaid, Medicare, or private insurance coverage, based on propensity score models. A majority of male VHA enrollees were similar to Medicare beneficiaries suggesting greater generalizability of VHA studies than commonly hypothesized. Overlap declined when comparing with Medicaid enrollees or privately insured individuals, suggesting more limited generalizability of VHA studies to these populations.

AbstractLanguage and reading acquisitions are strongly associated with a child's socioeconomic status (SES). There are a number of potential explanations for this relationship. We explore one potential explanation—a child's SES is associated with how children discriminate word-like sounds (i.e., phonological processing), a foundational skill for reading acquisition. Magnetoencephalography data from a sample of 71 children (aged 6 years and 11 months–12 years and 3 months), during a passive auditory oddball task containing word and nonword deviants, were used to test "where" (which sensors) and "when" (at what time) any association may occur. We also investigated associations between cognition, education, and this neurophysiological response. We report differences in the neural processing of word and nonword deviant tones at an early N200 component (likely representing early sensory processing) and a later P300 component (likely representing attentional and/or semantic processing). More interestingly we found "parental subjective" SES (the parents rating of their own relative affluence) was convincingly associated with later responses, but there were no significant associations with equivalized income. This suggests that the SES as rated by their parents is associated with underlying phonological detection skills. Furthermore, this correlation likely occurs at a later time point in information processing, associated with semantic and attentional processes. In contrast, household income is not significantly associated with these skills. One possibility is that the subjective assessment of SES is more impactful on neural mechanisms of phonological processing than the less complex and more objective measure of household income.

Massachusetts Health Reform (MHR), implemented in 2006, introduced new health insurance options that may have prompted some veterans already enrolled in the Veterans Affairs Healthcare System (VA) to reduce their reliance on VA health services. This study examined whether MHR was associated with changes in VA primary care (PC) use. Using VA administrative data, we identified 147,836 veterans residing in Massachusetts and neighboring New England (NE) states from October 2004 to September 2008. We applied difference-in-difference methods to compare pre–post changes in PC use among Massachusetts and other NE veterans. Among veterans not enrolled in Medicare, VA PC use was not significantly different following MHR for Massachusetts veterans relative to other NE veterans. Among VA–Medicare dual enrollees, MHR was associated with an increase of 24.5 PC visits per 1,000 veterans per quarter ( p = .048). Despite new non-VA health options through MHR, VA enrollees continued to rely on VA PC.

Literature indicates favorable selection among Medicare Advantage (MA) enrollees compared with fee-for-service (FFS) enrollees. This study examined whether favorable selection into MA affected readmission rates among Medicare-eligible veterans following hospitalization for congestive heart failure in the Veterans Affairs Health System (VA). We measured total (VA + Medicare FFS) 30-day all-cause readmission rates across hospitals and all of VA. We used Heckman's correction to adjust readmission rates to be representative of all Medicare-eligible veterans, not just FFS-enrolled veterans. The adjusted all-cause readmission rate among FFS veterans was 27.1% (95% confidence interval [CI] = 26.5% to 27.7%), while the adjusted readmission rate among Medicare-eligible veterans was 25.3% (95% CI = 23.6% to 27.1%) after correcting for favorable selection. Readmission rate estimates among FFS veterans generalize to all Medicare-eligible veterans only after accounting for favorable selection into MA. Estimation of quality metrics should carefully consider sample selection to produce valid policy inferences.

Cover -- Title -- Copyright -- Preface -- Contents -- "A Review History of British Regional Policy -- "Notes on a National Urban Development Strategy for the United States: Politics and Analytics" -- "The National System of Cities as an Object of Public Policy" -- "Optimality in City Size, Systems of Cities and Urban Policy: A Sceptics View" -- "The Agglomeration Process in Urban Growth" -- "Welfare Aspects of National Policy Toward City Sizes" -- "The Pure Theory of City Size in an Industrial Economy

Prior research examining the relationship between economic conditions and health service demand has focused primarily on outpatient use. This study examines whether local area unemployment, as an indicator of economic conditions, was associated with use of inpatient care, which is theoretically less subject to discretionary use. Using a random sample of 131,603 patients dually enrolled in the Veterans Affairs (VA) Health System and fee-for-service Medicare, we measured VA, Medicare, and total (VA and Medicare) hospitalizations. Overall, local unemployment was not associated with VA, Medicare, or total hospitalization probability. Among low-income veterans exempt from VA copayments, higher local unemployment was moderately associated with a lower probability of hospitalization through Medicare. For veterans subject to VA copayments, higher local unemployment was moderately associated with a higher likelihood of VA hospitalization. These results suggest inpatient use is less sensitive to the economy, although worse economic conditions slightly affected inpatient demand for select veterans.

Vol. II has imprint: Anaconda, Mont. : Standard Publishing Co., printers, 1895. ; I. Constitutions. Political Code. Civil Code / annotated by Edwin S. Booth -- II. Code of Civil Procedure. Penal Code / annotated by Fletcher Maddox. ; Mode of access: Internet.