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Spillover Effects of Massachusetts Health Reform on Mental Health Use by VA and Medicare Dual Enrollees

  • Edwin S. WongEmail author
  • Matthew L. Maciejewski
  • Paul L. Hebert
  • John C. Fortney
  • Chuan-Fen Liu
Original Article

Abstract

Older veterans can obtain care from the Veterans Affairs Health System (VA), Medicare or both. We examined whether their use of mental health care was impacted by capacity effects stemming from younger, uninsured veterans’ enrolling in VA to satisfy the individual mandate within Massachusetts Health Reform (MHR). Using administrative data, we applied a difference-in-difference approach to compare pre-post changes in mental health use following MHR implementation. Findings indicated MHR was associated with increases in use through Medicare and the probability of dual VA-Medicare use. These results provide support for the possibility that limited capacity led to care seeking outside VA.

Keywords

Healthcare reform Mental health Utilization Access Veterans affairs 

Notes

Funding

Dr. Wong is supported by a VA Health Services Research and Development Career Development Award (CDA 13-024). Dr. Maciejewski (RCS 10-391) and Dr. Fortney (RCS 17-153) are VA Research Career Scientists.

Compliance with Ethical Standards

Conflict of interest

Dr. Wong reports ownership of common stock in UnitedHealth Group Inc. All other authors declare they have no potential conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2018

Authors and Affiliations

  1. 1.Center for Veteran-Centered and Value-Driven CareVA Puget Sound Health Care SystemSeattleUSA
  2. 2.Department of Health ServicesUniversity of WashingtonSeattleUSA
  3. 3.Center for Health Services Research in Primary CareDurham VA Medical CenterDurhamUSA
  4. 4.Department of Population Health SciencesDuke UniversityDurhamUSA
  5. 5.Department of PsychiatryUniversity of WashingtonSeattleUSA

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