Effect of the Affordable Care Act on healthcare utilization for Veterans with spinal cord injuries and disorders

The Journal of Spinal Cord Medicine, 2022 · DOI: 10.1080/10790268.2020.1829419 · Published: October 8, 2020

Simple Explanation

This study examines how the Affordable Care Act (ACA) impacted healthcare use among veterans with spinal cord injuries and disorders (SCI/D). It looks at whether veterans used Department of Veterans Affairs (VA) healthcare facilities more or less after the ACA was implemented. The study compared VA healthcare use before (2012/13) and after (2014/15) the ACA implementation. They analyzed data on VA visits for SCI/D care, diagnostic care, primary care, specialty care, and mental health care, as well as VA admissions. Results showed that after the ACA, veterans with SCI/D had more VA admissions and visits for SCI/D and specialty care. However, they had fewer mental health visits. Veterans who lived closer to a VA facility used VA care more often.

Study Duration

2012/13 (pre-ACA) and 2014/15 (post-ACA)

Participants

8,591 VA users with SCI/D

Evidence Level

Not specified

Key Findings

1
The number of VA admissions was 7% higher in the post than pre-ACA implementation period.
2
The number of VA visits post-implementation increased for SCI/D care (8%) and specialty care (12%).
3
The number of VA mental health visits were 17% lower in the post-ACA implementation period.

Research Summary

This study investigated the impact of the Affordable Care Act (ACA) on healthcare utilization among Veterans with spinal cord injuries and disorders (SCI/D) within the Department of Veterans Affairs (VA) system. Counter to expectations, the study found that Veterans with SCI/D sought more frequent VA care after ACA implementation, particularly for SCI/D care and specialty care, suggesting continued reliance on VA's comprehensive services. However, there was a notable decrease in mental health visits post-ACA. Factors such as sex, injury level and duration, and proximity to VA facilities were also identified as influential in VA healthcare utilization patterns.

Practical Implications

Continued VA Reliance

Veterans with SCI/D continue to value and utilize the comprehensive care provided by the VA, even with increased insurance options through the ACA.

Mental Health Access

The decrease in mental health visits warrants further investigation to understand if veterans are accessing mental healthcare elsewhere or if there are unmet needs.

Telehealth Expansion

Given the impact of distance on VA utilization, expanding telehealth services could improve access to care for veterans in rural areas.

Study Limitations

1
The study could not assess the impact of ACA implementation on non-VA healthcare utilization.
2
The study design cannot definitively prove causation between ACA implementation and changes in VA utilization.
3
Other factors beyond the ACA may have influenced healthcare utilization patterns during the study period.

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