This study aimed to examine the early impact of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) on Veteran health care utilization and costs. A pre-post cohort design including a nonequivalent control group was used to understand how Veterans’ use of Veteran Affairs health care and total health care costs changed in 6-month intervals up to 3 years after PCAFC enrollment. The control group was an inverse probability of treatment weighted sample of Veterans whose caregivers applied for, but were not accepted into, PCAFC. Veterans in PCAFC had similar acute care utilization postenrollment when compared with those in the control group, but significantly greater primary, specialty, and mental health outpatient care use at least 30, and up to 36, months postenrollment. Estimated total health care costs for PCAFC Veterans were $1,500 to $3,400 higher per 6-month interval than for control group Veterans. PCAFC may have increased Veterans’ access to care.
Agency for Healthcare Research and Quality. (2016). Using appropriate price indices for analyses of health care expenditures or income across multiple years. Retrieved from https://meps.ahrq.gov/about_meps/Price_Index.shtml
AshA. S.EllisR. P.PopeG. C.AyanianJ. Z.BatesD. W.BurstinH.. . . YuW. (2000). Using diagnoses to describe populations and predict costs. Health Care Financing Review, 21(3), 7-28.
4.
AustinP. (2009). Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Statistics in Medicine, 28, 3083-3107.
5.
AustinP. (2011). An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behavioral Research, 46, 399-424.
6.
BrookhartM. A.SchneeweissS.RothmanK. J.GlynnR. J.AvornJ.SturmerT. (2006). Variable selection for propensity score models. American Journal of Epidemiology, 163, 1149-1156. doi:10.1093/aje/kwj149
7.
BrooksJ. M.OhsfeldtR. L. (2013). Squeezing the balloon: Propensity scores and unmeasured covariate balance. Health Services Research, 48, 1487-1507. doi:10.1111/1475-6773.12020
8.
BuntinM. B.DambergC.HavilandA.KapurK.LurieN.McDevittR.MarquisM. S. (2006). Consumer-directed health care: Early evidence about effects on cost and quality. Health Affairs (Millwood), 25, w516-w530. doi:10.1377/hlthaff.25.w516
9.
FeinbergL. F.NewmanS. L.FeinbergL. F.NewmanS. L. (2006). Preliminary experiences of the states in implementing the National Family Caregiver Support Program: A 50-state study. Journal of Aging & Social Policy, 18, 95-113.
10.
FosterL.DaleS. B.BrownR. (2007). How caregivers and workers fared in Cash and Counseling. Health Services Research, 42, 510-532. doi:10.1111/j.1475-6773.2006.00672.x
11.
Government Accountability Office. (2014). VA health care: Actions needed to address higher-than-expected demand for the family caregiver program. Washington, DC: Author.
12.
ImbensG. (2004). Nonparametric estimation of average treatment effects under exogeneity: A review.The Review of Economics and Statistics, 86, 4-29.
13.
KauermannG.CarrollR. (2001). A note on the efficiency of sandwich covariance matrix estimation. Journal of the American Statistical Association, 96, 1387-1396.
14.
LaPlanteM. P.KayeH. S.HarringtonC. (2007). Estimating the expense of a mandatory home-and community-based personal assistance services benefit under Medicaid. Journal of Aging & Social Policy, 19, 47-64. doi:10.1300/J031v19n03_04
LuncefordJ.DavidianM. (2004). Stratification and weighting via the propensity score in estimation of causal treatment effects: A comparative study. Statistics in Medicine, 23, 2937-2960.
17.
ManningW. G.MullahyJ. (2001). Estimating log models: To transform or not to transform?Journal of Health Economics, 20, 461-494.
18.
McCarthyJ. F.BlowF. C. (2004). Older patients with serious mental illness: Sensitivity to distance barriers for outpatient care. Medical Care, 42, 1073-1080.
19.
MillerK.KabatM.HeniusJ.Van HoutvenC. (2015). Engaging, supporting, and sustaining the invisible partners in care: Young caregivers of veterans from the post-9/11 era. North Carolina Medical Journal, 76, 320-322. doi:10.18043/ncm.76.5.320
20.
NewcomerR. J.KangT.DotyP. (2012). Allowing spouses to be paid personal care providers: Spouse availability and effects on Medicaid-funded service use and expenditures. The Gerontologist, 52, 517-530. doi:10.1093/geront/gnr102
21.
PhibbsC.ScottJ.FloresN.BarnettP. (2010). HERC’s outpatient average cost dataset for VA care: Fiscal year 2009 update. Palo Alto, VA: Health Economics Resource Center.
22.
RamchandR.TanielianT.FisherM.VaughanC.TrailT.BatkaC.. . . Ghosh-DastidaB. (2014). Hidden heroes: America’s military caregivers. Santa Monica, CA: RAND.
23.
RosenbaumP. (1987). Model-based direct adjustment. Journal of the American Statistician, 82, 387-394.
24.
RoyallR. (1986). Model robust confidence intervals using maximum likelihood estimators. International Statistical Review, 54, 221-226.
25.
StarfieldB.ShiL.MacinkoJ. (2005). Contribution of primary care to health systems and health. Milbank Quarterly, 83, 457-502. doi:10.1111/j.1468-0009.2005.00409.x
26.
StroupeK. T.SmithB. M. (2013). Healthcare utilization and costs of Veterans screened and assessed for traumatic brain injury. Journal of Rehabilitation Research & Development, 50, 1047-1068. doi:10.1682/JRRD.2012.06.0107
27.
StuartE. A. (2010). Matching methods for causal inference: A review and a look forward. Statistical Science, 25, 1-21. doi:10.1214/09-STS313
28.
Van HoutvenC.VoilsC.WeinbergerM. (2011). An organizing framework for informal caregiver interventions: Detailing caregiving activities and caregiver and care recipient outcomes to optimize evaluation efforts. BioMed Central-Geriatrics, 11, 77. doi:10.1186/1471-2318-11-77
29.
VanderWeeleT. J.ShpitserI. (2011). A new criterion for confounder selection. Biometrics, 67, 1406-1413. doi:10.1111/j.1541-0420.2011.01619.x
30.
Veterans Health Administration (2012). 2012 VHA facility quality and safety report. Office of informatics and business analytics. Department of Veterans Affairs, VHA, US.
WagnerT.ChowA.BarnettP. (2009). HERC’s average cost datasets for VA inpatient care FY1998–FY2008. Palo Alto, VA: Health Economics Resource Center.
33.
WagnerT.UpadhyayA.CowgillE.SterfosT.MoranE.AschS.AlmenoffP. (2016). Risk adjustment tools for learning health systems: A comparison of DxCG and CMS-HCC V21. Health Services Research, 51, 2002-2019.
