Is There a VA Advantage? Evidence from Dually Eligible Veterans
We study public vs. private provision of health care for veterans aged 65 and older who may receive care provided by the US Department of Veterans Affairs (VA) and in private hospitals financed by Medicare. Utilizing the ambulance design of Doyle et al. (2015), we find that the VA reduces 28-day mortality by 46% (4.5 percentage points) and that these survival gains are persistent. The VA also reduces 28-day spending by 21% and delivers strikingly different reported services relative to private hospitals. We find suggestive evidence of complementarities between continuity of care, health IT, and integrated care.
We thank Steve Asch, Zarek Brot-Goldberg, Marika Cabral, Joe Doyle, Amy Finkelstein, Josh Gottlieb, Kate Ho, Peter Hull, Bob Kaestner, Chad Kessler, Tim Layton, Carol Propper, Michael McWilliams, Maria Polyakova, Jim Rebitzer, Adam Sacarny, David Silver, Anita Vashi, Todd Wagner, and Chris Walters for helpful comments and suggestions. We also thank Sophie Andrews, Noah Boden-Gologorsky, Sydney Costantini, Kaveh Danesh, Akriti Dureja, Johnny Huynh, Kevin Kloiber, Uyseok Lee, Chris Lim, Matthew Merrigan, Kevin Todd, Justine Weng, and Saam Zahedian for excellent research assistance. Finally, we thank Melissa Taylor for valuable insight concerning our research design. Chan gratefully acknowledges generous support from VA HSR&D I01HX002631, the Laura and John Arnold Foundation, and the Stanford Institute for Economic Policy Research. The contents of this paper do not represent the views of VA or the United States Government. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.