Medical Care Hardship, Chronic Illness and Health Insurance Status Among Veterans

Background:

Although some veterans have access to more than one source of health care, the Veteran Health Administration (VA) as well as private insurance or other public coverage such as Medicare or Medicaid, some veterans were found to have no health coverage at all. In terms of chronic conditions, it is known that chronically ill veterans interface with the health care system more than any other veterans. As a result of chronic illness and limitations in health coverage, veterans are vulnerable to a range of health care hardships. The study addresses three vital questions. First, how does the prevalence of health care hardship differ by health insurance coverage, and by chronic conditions among veterans? Second, what is the impact of health insurance on health care hardship? Third, how does the interaction of health insurance and chronic illness affect hardship? Does this association differ by socioeconomic status (poverty status, disability status, and unemployment status)? This study fills the knowledge gap by assessing the chronic illness, health insurance, and health care hardship among veterans.

Methods:

The paper uses the 2014 National Health Interview Survey (NHIS), which was collected by the National Center for Health Statistics, US Department of Health and Human Services (DHHS). The NHIS is an annual, ongoing, cross-sectional national representative household survey of non-institutionalized civilians living in the country. The NHIS data have been widely used by DHHS to monitor trends in illness and to track progress toward achieving national health objectives, and evaluating health care utilization. Two dependent variables were employed to examine difficulties in receiving health care: delayed medical care because of cost, and unable to pay medical bill. The independent variable is a series of dichotomous variables of different health insurance coverage. The interaction terms is constructed by utilizing health insurance and chronic illness indicators. Logistic regressions were employed to predict the likelihood of having hardships.

Results:

There were 7,193 veterans participating the 2014 NHIS study. They had access to a wide range of health insurance coverage: military, private, Medicare, Medicaid, Medi-Gap, or other types of public programs. The top three types of coverage were private (50.78%), Medicare (42.16%), and military (30.35%), respectively. Having no health coverage significantly increased the odds of delaying medical care and not paying medical bill.  These relationships were deteriorated by chronic illness conditions.

Conclusions and implications:

The research findings indicate that the association of health insurance coverage and health care hardship varied across subgroups and affected by chronic illness conditions. The implications of these findings show the need for veterans medical care hardship programs.