Skip to main content
Top
Published in: BMC Health Services Research 1/2010

Open Access 01-12-2010 | Research article

Comparison of outpatient health care utilization among returning women and men Veterans from Afghanistan and Iraq

Authors: Mona Duggal, Joseph L Goulet, Julie Womack, Kirsha Gordon, Kristin Mattocks, Sally G Haskell, Amy C Justice, Cynthia A Brandt

Published in: BMC Health Services Research | Issue 1/2010

Login to get access

Abstract

Background

The number of women serving in the United States military increased during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), leading to a subsequent surge in new women Veterans seeking health care services from the Veterans Administration (VA). The objective of this study was to examine gender differences among OEF/OIF Veterans in utilization of VA outpatient health care services.

Methods

Our retrospective cohort consisted of 1,620 OEF/OIF Veterans (240 women and 1380 men) who enrolled for outpatient healthcare at a single VA facility. We collected demographic data and information on military service and VA utilization from VA electronic medical records. To assess gender differences we used two models: use versus nonuse of services (logistic regression) and intensity of use among users (negative binomial regression).

Results

In our sample, women were more likely to be younger, single, and non-white than men. Women were more likely to utilize outpatient care services (odds ratio [OR] = 1.47, 95% confidence interval [CI]:1.09, 1.98), but once care was initiated, frequency of visits over time (intensity) did not differ by gender (incident rate ratio [IRR] = 1.07; 95% CI: 0.90, 1.27).

Conclusion

Recently discharged OEF/OIF women Veterans were more likely to seek VA health care than men Veterans. But the intensity of use was similar between women and men VA care users. As more women use VA health care, prospective studies exploring gender differences in types of services utilized, health outcomes, and factors associated with satisfaction will be required.
Literature
4.
go back to reference Blimes L: Soldiers Returning from Iraq and Afghanistan: The Long-term Costs of Providing Veterans Medical Care and Disability Benefits. KSG Faculty Research Working Paper Series. 2007, RWP07-001: 1-20. Blimes L: Soldiers Returning from Iraq and Afghanistan: The Long-term Costs of Providing Veterans Medical Care and Disability Benefits. KSG Faculty Research Working Paper Series. 2007, RWP07-001: 1-20.
5.
go back to reference Mustard CA, Kaufert P, Kozyrskyj A, Mayer T: Sex differences in the use of health care services. N Engl J Med. 1998, 338 (23): 1678-1683. 10.1056/NEJM199806043382307.CrossRefPubMed Mustard CA, Kaufert P, Kozyrskyj A, Mayer T: Sex differences in the use of health care services. N Engl J Med. 1998, 338 (23): 1678-1683. 10.1056/NEJM199806043382307.CrossRefPubMed
6.
go back to reference Kjerulff KH, Frick KD, Rhoades JA, Hollenbeak CS: The cost of being a woman: a national study of health care utilization and expenditures for female-specific conditions. Womens Health Issues. 2007, 17 (1): 13-21. 10.1016/j.whi.2006.11.004.CrossRefPubMed Kjerulff KH, Frick KD, Rhoades JA, Hollenbeak CS: The cost of being a woman: a national study of health care utilization and expenditures for female-specific conditions. Womens Health Issues. 2007, 17 (1): 13-21. 10.1016/j.whi.2006.11.004.CrossRefPubMed
7.
go back to reference Verbrugge LM: Work satisfaction and physical health. J Community Health. 1982, 7 (4): 262-283. 10.1007/BF01318959.CrossRefPubMed Verbrugge LM: Work satisfaction and physical health. J Community Health. 1982, 7 (4): 262-283. 10.1007/BF01318959.CrossRefPubMed
8.
go back to reference Verbrugge LM: Gender and health: an update on hypotheses and evidence. J Health Soc Behav. 1985, 26 (3): 156-182. 10.2307/2136750.CrossRefPubMed Verbrugge LM: Gender and health: an update on hypotheses and evidence. J Health Soc Behav. 1985, 26 (3): 156-182. 10.2307/2136750.CrossRefPubMed
9.
go back to reference Gijsbers van Wijk CM, van Vliet KP, Kolk AM, Everaerd WT: Symptom sensitivity and sex differences in physical morbidity: a review of health surveys in the United States and The Netherlands. Women Health. 1991, 17 (1): 91-124. 10.1300/J013v17n01_06.CrossRefPubMed Gijsbers van Wijk CM, van Vliet KP, Kolk AM, Everaerd WT: Symptom sensitivity and sex differences in physical morbidity: a review of health surveys in the United States and The Netherlands. Women Health. 1991, 17 (1): 91-124. 10.1300/J013v17n01_06.CrossRefPubMed
10.
go back to reference Macintyre S, Hunt K, Sweeting H: Gender differences in health: are things really as simple as they seem?. Soc Sci Med. 1996, 42 (4): 617-624. 10.1016/0277-9536(95)00335-5.CrossRefPubMed Macintyre S, Hunt K, Sweeting H: Gender differences in health: are things really as simple as they seem?. Soc Sci Med. 1996, 42 (4): 617-624. 10.1016/0277-9536(95)00335-5.CrossRefPubMed
11.
go back to reference Luce PJB: Addressing the women’s needs.2nd Annual Veteran Symposium. University of Louisville. Louisville ,KY.22-23 Feb 2010. Luce PJB: Addressing the women’s needs.2nd Annual Veteran Symposium. University of Louisville. Louisville ,KY.22-23 Feb 2010.
12.
go back to reference Ladwig KH, Marten-Mittag B, Formanek B, Dammann G: Gender differences of symptom reporting and medical health care utilization in the German population. Eur J Epidemiol. 2000, 16 (6): 511-518. 10.1023/A:1007629920752.CrossRefPubMed Ladwig KH, Marten-Mittag B, Formanek B, Dammann G: Gender differences of symptom reporting and medical health care utilization in the German population. Eur J Epidemiol. 2000, 16 (6): 511-518. 10.1023/A:1007629920752.CrossRefPubMed
13.
go back to reference Parslow R, Jorm A, Christensen H, Jacomb P, Rodgers B: Gender differences in factors affecting use of health services: an analysis of a community study of middle-aged and older Australians. Soc Sci Med. 2004, 59 (10): 2121-2129. 10.1016/j.socscimed.2004.03.018.CrossRefPubMed Parslow R, Jorm A, Christensen H, Jacomb P, Rodgers B: Gender differences in factors affecting use of health services: an analysis of a community study of middle-aged and older Australians. Soc Sci Med. 2004, 59 (10): 2121-2129. 10.1016/j.socscimed.2004.03.018.CrossRefPubMed
14.
go back to reference Dunlop S, Coyte PC, McIsaac W: Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey. Soc Sci Med. 2000, 51 (1): 123-133. 10.1016/S0277-9536(99)00424-4.CrossRefPubMed Dunlop S, Coyte PC, McIsaac W: Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey. Soc Sci Med. 2000, 51 (1): 123-133. 10.1016/S0277-9536(99)00424-4.CrossRefPubMed
15.
go back to reference Mueller KJ, Patil K, Boilesen E: The role of uninsurance and race in healthcare utilization by rural minorities. Health Serv Res. 1998, 33 (3 Pt 1): 597-610.PubMedPubMedCentral Mueller KJ, Patil K, Boilesen E: The role of uninsurance and race in healthcare utilization by rural minorities. Health Serv Res. 1998, 33 (3 Pt 1): 597-610.PubMedPubMedCentral
16.
go back to reference Hoff RA, Rosenheck RA: Female veterans' use of Department of Veterans Affairs health care services. Med Care. 1998, 36 (7): 1114-1119. 10.1097/00005650-199807000-00017.CrossRefPubMed Hoff RA, Rosenheck RA: Female veterans' use of Department of Veterans Affairs health care services. Med Care. 1998, 36 (7): 1114-1119. 10.1097/00005650-199807000-00017.CrossRefPubMed
17.
go back to reference Hoff RA, Rosenheck RA: Utilization of mental health services by women in a male-dominated environment: the VA experience. Psychiatr Serv. 1997, 48 (11): 1408-1414.CrossRefPubMed Hoff RA, Rosenheck RA: Utilization of mental health services by women in a male-dominated environment: the VA experience. Psychiatr Serv. 1997, 48 (11): 1408-1414.CrossRefPubMed
18.
go back to reference Burgess JF, DeFiore DA: The effect of distance to VA facilities on the choice and level of utilization of VA outpatient services. Soc Sci Med. 1994, 39 (1): 95-104. 10.1016/0277-9536(94)90169-4.CrossRefPubMed Burgess JF, DeFiore DA: The effect of distance to VA facilities on the choice and level of utilization of VA outpatient services. Soc Sci Med. 1994, 39 (1): 95-104. 10.1016/0277-9536(94)90169-4.CrossRefPubMed
19.
go back to reference LaVela SL, Smith B, Weaver FM, Miskevics SA: Geographical proximity and health care utilization in veterans with SCI&D in the USA. Soc Sci Med. 2004, 59 (11): 2387-2399. 10.1016/j.socscimed.2004.06.033.CrossRefPubMed LaVela SL, Smith B, Weaver FM, Miskevics SA: Geographical proximity and health care utilization in veterans with SCI&D in the USA. Soc Sci Med. 2004, 59 (11): 2387-2399. 10.1016/j.socscimed.2004.06.033.CrossRefPubMed
21.
go back to reference Asada YKG: Equity in health services use and intensity of use in Canada. BMC Health Services Research. BMC Health Services Research. 2007, 7: 41-10.1186/1472-6963-7-41.CrossRefPubMedPubMedCentral Asada YKG: Equity in health services use and intensity of use in Canada. BMC Health Services Research. BMC Health Services Research. 2007, 7: 41-10.1186/1472-6963-7-41.CrossRefPubMedPubMedCentral
22.
go back to reference Duan N, Manning WG, Morris CN, Newhouse JP: A Comparison of Alternative Models for the Demand for Medical Care. Journal of Business & Economic Statistics. 1983, 1 (2): 115-126. 10.2307/1391852. Duan N, Manning WG, Morris CN, Newhouse JP: A Comparison of Alternative Models for the Demand for Medical Care. Journal of Business & Economic Statistics. 1983, 1 (2): 115-126. 10.2307/1391852.
23.
go back to reference Rosenheck R, Massari L: Wartime military service and utilization of VA health care services. Mil Med. 1993, 158 (4): 223-228.PubMed Rosenheck R, Massari L: Wartime military service and utilization of VA health care services. Mil Med. 1993, 158 (4): 223-228.PubMed
24.
go back to reference Wolinsky FD, Coe RM, Mosely RR, Homan SM: Veterans' and nonveterans' use of health services. A comparative analysis. Med Care. 1985, 23 (12): 1358-1371. 10.1097/00005650-198512000-00005.CrossRefPubMed Wolinsky FD, Coe RM, Mosely RR, Homan SM: Veterans' and nonveterans' use of health services. A comparative analysis. Med Care. 1985, 23 (12): 1358-1371. 10.1097/00005650-198512000-00005.CrossRefPubMed
25.
go back to reference Maciejewski ML, Perkins M, Li YF, Chapko M, Fortney JC, Liu CF: Utilization and expenditures of veterans obtaining primary care in community clinics and VA medical centers: an observational cohort study. BMC Health Services Research. 2007, 7: 56-10.1186/1472-6963-7-56.CrossRefPubMedPubMedCentral Maciejewski ML, Perkins M, Li YF, Chapko M, Fortney JC, Liu CF: Utilization and expenditures of veterans obtaining primary care in community clinics and VA medical centers: an observational cohort study. BMC Health Services Research. 2007, 7: 56-10.1186/1472-6963-7-56.CrossRefPubMedPubMedCentral
26.
go back to reference Hall JA, Dornan MC: Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis. Soc Sci Med. 1990, 30 (7): 811-818. 10.1016/0277-9536(90)90205-7.CrossRefPubMed Hall JA, Dornan MC: Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis. Soc Sci Med. 1990, 30 (7): 811-818. 10.1016/0277-9536(90)90205-7.CrossRefPubMed
28.
go back to reference Pierce PF, Antonakos C, Deroba BA: Health care utilization and satisfaction concerning gender-specific health problems among military women. Mil Med. 1999, 164 (2): 98-102.PubMed Pierce PF, Antonakos C, Deroba BA: Health care utilization and satisfaction concerning gender-specific health problems among military women. Mil Med. 1999, 164 (2): 98-102.PubMed
30.
go back to reference Vogt D, Bergeron A, Salgado D, Daley J, Ouimette P, Wolfe J: Barriers to Veterans Health Administration care in a nationally representative sample of women veterans. J Gen Intern Med. 2006, 21 (Suppl 3): S19-25. 10.1111/j.1525-1497.2006.00370.x.CrossRefPubMedPubMedCentral Vogt D, Bergeron A, Salgado D, Daley J, Ouimette P, Wolfe J: Barriers to Veterans Health Administration care in a nationally representative sample of women veterans. J Gen Intern Med. 2006, 21 (Suppl 3): S19-25. 10.1111/j.1525-1497.2006.00370.x.CrossRefPubMedPubMedCentral
31.
go back to reference United States Congress House Committee on Veterans' Affairs, Subcommittee on Oversight and Investigations: VA provision of health care to women veterans and related issues. One Hundred Third Congress. 1993, 64/3 (first): 103-119. United States Congress House Committee on Veterans' Affairs, Subcommittee on Oversight and Investigations: VA provision of health care to women veterans and related issues. One Hundred Third Congress. 1993, 64/3 (first): 103-119.
32.
go back to reference Yano EM, Goldzweig C, Canelo I, Washington DL: Diffusion of innovation in women's health care delivery: the Department of Veterans Affairs' adoption of women's health clinics. Womens Health Issues. 2006, 16 (5): 226-235. 10.1016/j.whi.2006.07.002.CrossRefPubMed Yano EM, Goldzweig C, Canelo I, Washington DL: Diffusion of innovation in women's health care delivery: the Department of Veterans Affairs' adoption of women's health clinics. Womens Health Issues. 2006, 16 (5): 226-235. 10.1016/j.whi.2006.07.002.CrossRefPubMed
33.
go back to reference Washington DL, Yano EM, Simon B, Sun S: To use or not to use. What influences why women veterans choose VA health care. Journal of General Internal Medicine. 2006, 21 (Suppl 3): S11-8. 10.1111/j.1525-1497.2006.00369.x.CrossRefPubMedPubMedCentral Washington DL, Yano EM, Simon B, Sun S: To use or not to use. What influences why women veterans choose VA health care. Journal of General Internal Medicine. 2006, 21 (Suppl 3): S11-8. 10.1111/j.1525-1497.2006.00369.x.CrossRefPubMedPubMedCentral
35.
go back to reference Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL: Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004, 351 (1): 13-22. 10.1056/NEJMoa040603.CrossRefPubMed Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL: Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004, 351 (1): 13-22. 10.1056/NEJMoa040603.CrossRefPubMed
36.
go back to reference Carney CP, Sampson TR, Voelker M, Woolson R, Thorne P, Doebbeling BN: Women in the Gulf War: combat experience, exposures, and subsequent health care use. Mil Med. 2003, 168 (8): 654-661.PubMed Carney CP, Sampson TR, Voelker M, Woolson R, Thorne P, Doebbeling BN: Women in the Gulf War: combat experience, exposures, and subsequent health care use. Mil Med. 2003, 168 (8): 654-661.PubMed
37.
go back to reference Nice DS, Hilton S: Sex differences and occupational influences on health care utilization aboard US Navy Ships. Military Psychology. 1994, 6 (2): 109-123. 10.1207/s15327876mp0602_3.CrossRef Nice DS, Hilton S: Sex differences and occupational influences on health care utilization aboard US Navy Ships. Military Psychology. 1994, 6 (2): 109-123. 10.1207/s15327876mp0602_3.CrossRef
38.
go back to reference McNeil M, Hayes P: Women's health care in the VA system: another "patchwork quilt". Womens Health Issues. 2003, 13 (2): 47-49. 10.1016/S1049-3867(03)00025-2.CrossRefPubMed McNeil M, Hayes P: Women's health care in the VA system: another "patchwork quilt". Womens Health Issues. 2003, 13 (2): 47-49. 10.1016/S1049-3867(03)00025-2.CrossRefPubMed
39.
go back to reference Laine C, Davidoff F, Lewis CE, Nelson EC, Nelson E, Kessler RC, Delbanco TL: Important Elements of Outpatient Care: A Comparison of Patients' and Physicians' Opinions. Ann Intern Med. 1996, 125 (8): 640-645.CrossRefPubMed Laine C, Davidoff F, Lewis CE, Nelson EC, Nelson E, Kessler RC, Delbanco TL: Important Elements of Outpatient Care: A Comparison of Patients' and Physicians' Opinions. Ann Intern Med. 1996, 125 (8): 640-645.CrossRefPubMed
Metadata
Title
Comparison of outpatient health care utilization among returning women and men Veterans from Afghanistan and Iraq
Authors
Mona Duggal
Joseph L Goulet
Julie Womack
Kirsha Gordon
Kristin Mattocks
Sally G Haskell
Amy C Justice
Cynthia A Brandt
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2010
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-10-175

Other articles of this Issue 1/2010

BMC Health Services Research 1/2010 Go to the issue