Evaluating Dynamic Trends in Veteran Enrollment and Health Care Utilization in the Veterans Health Administration From 2018 to 2021.

Abstract

Background: The impact of the COVID-19 pandemic on Veteran enrollment and health care utilization within the United States Veterans Health Administration (VHA) remains uncertain.

Objective: To evaluate drivers of enrollment and utilization of health care services at VHA with an emphasis on differences before and during the COVID-19 pandemic.

Methods: We included 14,107,785 Veterans from the US Veterans Eligibility Trends and Statistics (USVETS) FY2017-2021 annual datasets in a repeat cross-sectional design. We assessed the adjusted incidence of VHA enrollment, and the probability of utilizing VHA health care by fiscal year among social determinants of health, including number of children, attained education, income, marital status, household size, and rurality of residence.

Results: Contrary to prepandemic years, Veterans with adverse or negative social determinants of health that can lead to poor health (eg, lower income and lower attained education) were less likely than other groups to enroll in FY2021. However, among those enrolled, the probability of using VHA health care service increased by (1%-2%) in FY2021 across all social determinants of health. The largest increases in the probability of VHA health care use were among Veterans with higher income, higher education, and those living in urban areas.

Conclusions: Veterans with adverse social determinants of health, that could lead to poor health, showed decreased VHA enrollment during FY2021. During the same time period, the largest utilization increases occurred among Veterans facing fewer adverse social determinants of health, highlighting nuanced socioeconomic dynamics and need for dedicated programs to ensure equitable care and access during significant societal disruptions.