VA Utilization Profile FY 2017 - Veterans Affairs

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VA Utilization ProfileFY 2017Prepared by the National Center for Veterans Analysis and StatisticsMay 2020NCVAS National Center for Veterans Analysis and Statistics

IntroductionWith a budget of 180 billion in fiscal year 2017, the Department of Veterans Affairs (VA) is committed to delivering a wide array of benefits andservices to eligible Veterans, dependents, and survivors to help to ease the transition from the military to civilian life and to improve quality of lifeafter service. Considering the magnitude of this commitment it is important for the VA and key VA stakeholders to be aware of basic characteristicsof the Veteran population being served and the benefits and services provided. VA programs are overseen by three administrations: Veterans Health Administration (VHA) provides Health Care and Pharmacy services Veterans Benefits Administration (VBA) provides Compensation and Pension disability benefits, Education Assistance, Life Insurance, VocationalRehabilitation/employment services, and Home Loan Guaranty assistance National Cemetery Administration (NCA) provides memorial benefits including graves, markers, flags, medallions, and burial allowancesThe National Center for Veterans Analysis and Statistics (NCVAS) conducted a study on Veterans who have used at least one of 22 benefits orservices provided by the VA during Fiscal Years 2008 through 2017. The analysis included a comparison by various characteristics to Veterans whodid not use any VA benefits. Veterans who used at least one benefit or service are termed ‘users’ and Veterans who did not are termed ‘non-users’.Key questions addressed in this study are: How many Veterans used VA benefits? How many did not? Which programs do Veterans use most? What are the demographic and socio-economic characteristics of VA users and how do they differ from non-users? We examined thefollowing characteristics:– Gender– Age– Period of Service– Race/Ethnicity Compensation & Health Care– How many Veterans receive disability Compensation and/or use VA Health Care?– How many disabled Veterans do not use VA Health Care?– Is the number of disabled Veterans not using VA Health Care going up or down?2

Key Findings 49% (9.8 out of 20.0 million) of all Veterans used at least one VA benefit or service in FY 2017, anincrease of almost 11 percentage points (39% or 9.0 out of 23.3 million) since FY 2008. Of the 9.8 millionusers, 45% used multiple benefits which is up from 33% in 2008 The percent of female Veterans who used VA benefits increased from 36% in 2008 to 50% in 2017. Thecorresponding rate among male Veterans in 2008 and 2017 was 39% and 49%, respectively. VA Health Care and/or Disability Compensation users accounted for 76% of all VA users in FY 2017, upfrom 69% in FY 2008 25% of all VA users only received Health care benefits in FY 2017 70% of Veterans receiving Disability Compensation used VA Health Care in FY 2017, up from 60% inFY 2008 Median age of male Veterans who used at least one VA benefit is 64; median age of male non-users is 58 Median age of female Veterans who used at least one VA benefit is 48; median age of female non-usersis 48 Veterans between the ages of 25 and 34 and over age 65 are more likely to use VA benefits compared toVeterans of other ages.3

Approximately 9.8 million Veterans used at least one VA benefit or service in FY 2017.45% of all VA users received benefits or services from multiple programs.*VA Benefits Utilization by Program - Veterans only: FY 2017Health Care6.1Compensationor Pension4.8LoanGuaranty**2.9Life InsuranceAbout 7.3 million Veteransused at least one benefitprovided by the VeteransBenefits Administration ehab.0.101234567Number of Veterans (Millions)* The numbers from the chart do not sum to the total number of VA users. Veterans who used multiple programs are counted in each individual program, butonly once in the overall total.** Contains Veterans who received Special Housing Allowance or Special Adaptive Housing benefits.Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and Statistics4

Health Care and Disability Compensation/Pension account for the majority of VA utilization and showsignificant growth since 2008.* Health Care and DisabilityCompensation/Pension, the largest programs,increased by 21% and 47%, respectively,between 2008 and 2017.Number of Users by Program: FY 2008-2017Millions6.56.0 The number of Veterans with an active, VA LifeInsurance policy has declined steadily at anaverage annual rate of 4.7%; almost 3 timesthe average annual rate of decline (1.7%) in theoverall Veteran population over the same timeperiod. Home Loan Guaranty program had a sharpdecline in 2009 consistent with the overallhousing market, but afterward has increasedsteadily through 2017 Education benefit use among Veterans wasstable through 2010, but trends upwardmarkedly after 2011, followed by subtledecline in 20135.5Health Care5.04.5Compensation/Pension4.03.53.02.5Loan Guaranty2.01.5Life Insurance1.0MemorialEducation0.5Voc. Rehab.0.0 Memorial Benefit and Vocational Rehabilitationuse have remained relatively steady.Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and * The numbers from the chart do not sum to the total number of VA users each year.Veterans who used multiple programs are counted in each individual program, but onlyonce in the overall total.5

The number of Veterans using VA benefits is increasing despite a 14% decline in the total Veteranpopulation since 2008.Benefit UseFY 2008-2017(millions)23.3Total Veteranpopulation20.0Did not usebenefits14.3Used at leastone benefit% %2008200920102011201220132014201520162017Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and Statistics6

The rate of growth in the number of female Veterans who used VA is over 5 times the rateof growth of the overall female Veteran population.Number of Female Veterans Who Used VA BenefitsFY 2008-2017 Number of female Veteran users increased by51.8% since 2008 while the total number offemale Veterans increased by only 9.8%(In Thousands)1,000 Number of female Veterans grew at an averageannual rate of 1.0% between FY 2008 and 2017,while the number who used VA benefits hasgrown at an average rate of 4.8% The utilization rate of VA benefits among femaleVeterans increased from 36.3% in 2008 to 50.3%in 2017800600400200 Female Veterans made up 9.6% of all users in2017, up from 7.0% in ans who Used VA Benefits and Servicesby Gender FY 62017Number of VA Users8,964,124 8,579,872 8,789,694 8,908,323 9,061,299 9,240,704 9,350,828 9,526,480 9,669,748 9,828,570Male8,340,810 7,967,650 8,137,209 8,231,909 8,341,280 8,463,035 8,554,339 8,690,885 8,798,891 8,882,230Female623,314612,222652,485Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and 57946,3407

Female Veterans who use VA, with a median age of 48, tend to be younger than male VA users (medianage of 64).Age Distribution of Veterans who used VA Benefits, 2017Male Veteran UsersFemale Veteran .99.255.172.823.501.1Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and Statistics8

Female Veterans, for the first time in 2017, were slightly more likely to use VA benefits than maleVeterans (utilization rate of 50.3% compared to 49.0%).Utilization Rate,2017VA Benefit Utilization Rate for Male Veteransby Age Group(in percent)VA Benefit Utilization Rate for Female Veteransby Age Group(in percent)79.371.8Overall rate: 49.0Overall rate: .333.627.0Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and Statistics9

Native Hawaiian/Pacific Islander, Black (AA), and Hispanic Veterans have a higher utilization rate of VAbenefits than any other racial group while American Indian/Alaskan native and Other race Veterans arethe least likely to utilize VA benefits.VA Utilization Rate by Race/Ethnicity: FY 2017(in percent)Overall rate: -AmericanAsianSource: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and StatisticsAmerican Indian/Alaskan-NativeNative Hawaiian/Pacific IslanderHispanic*Other***Hispanic of any race. All other race categories are assumedto be non-Hispanic.10**Includes Veterans of two or more races.

Most male Veterans served during the Vietnam Era and most female Veterans served during the Post9/11 Gulf War era. WWII and Korean Conflict Veterans are much more likely to use VA benefits andservice than other cohorts.Distribution of Male VA Users by Period of Military Service(in percent)Age Distribution,2017Distribution of Female VA Users by Period of Military Service(in percent)49.132.826.514.75.17.24.1VA Benefit Utilization Rate for Male Veteransby Period of Service(in percent)74.1Overall rate: 49.069.651.422.113.7Utilization Rate,201713.28.8VA Benefit Utilization Rate for Female Veteransby Period of Service(in percent)83.476.2Overall rate: 50.360.658.545.644.730.6Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and Statistics2.646.830.911

VA Health Care and DisabilityCompensationVA Health Care and Disability Compensation are the two most frequently usedprograms by our nation’s Veterans. In 2017, these two programs aloneaccounted for 77% of all VA expenditures ( 140 billion out of 181 billion).Thus, it is critical that we understand the interaction between Veterans’service-connected disability and their utilization of VA health care services.12

Since 2014, Health Care and Disability Compensation benefits account for 76 percent of all VAutilization.Utilization by Health Care or Compensation and all other benefits(in percent)All otherbenefitsHealth care 75.9Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and Statistics13

Service-connected disabled Veterans using VA Health Care increased from 60% in 2008 to 70% in 2017.Over 93% of service-connected disabled Veterans were enrolled in VHA Health Care system in 2017.VHA Enrollment Status and Health Care Utilization among Service-Connected Disabled Veterans(in percent)Not enrolled16.1Enrolled, butdid not usehealth care23.7Enrolled &used 69.769.662.113.5Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and Statistics14

Likelihood of Service-connected disabled Veterans seeking VA Health Care generally increases with theVeteran’s disability rating. The overall VHA utilization rate among disabled Veterans is 69.6%.Service-connected Disabled Veterans Receiving Compensation and VA Health Care Useby Disability Rating: FY 2017(in percent)Average VHA utilizationrate 69.9%Disabled,but did notuse healthcare56.546.553.5Disabled &used 20.418.916.279.681.183.810.889.243.5Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and Statistics15

The likelihood of a disabled Veteran to seek treatment from a VA Health Care facility varies with race and ethnicity;however, rates for Black Veterans are much higher than the average utilization rate of 69.6%.Service-connected Disabled Veterans Receiving Compensation andVA Health Care use by Race/Ethnicity: FY 2017Average VHAUtilization rate 69.6Disabled,but did notuse healthcareDisabled &used healthcare(in percent)22.632.437.577.467.6Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and panic of any race. All other race categories are assumed tobe non-Hispanic.**Includes Veterans of two or more races.16

Comparison ofVA Users and Non-UsersFY 2017Since, 2008 the proportion of Veterans who used VA benefits in agiven year has increased from 39% to 49% in 2017. With thisincrease in demand for VA services, it is important to understand thedifferences between Veterans who choose and those who do not andwhat may drive some of those decisions.Veterans who used VA Benefits:9,828,570Veterans who did not use VA Benefits:10,170,229Source: U.S. Veterans Eligibility Trends and Statistics, 2017 and VetPop2016Prepared by the National Center for Veterans Analysis and Statistics17

Male Veterans who used VA benefits tend to be older than those who do not. However, female usersand non-users are relatively similar in age.Utilization Status,MaleMedianAgeUsed VA benefits64Did not use VAbenefits58Age Distribution of Male VA Users and Non-users, 2017(in percent)Male Veteran UsersMale Non-users26.720.09.9 8.610.811.213.821.622.914.512.38.74.21.1 2.8Utilization Status,FemaleMedianAgeUsed VA benefits48Did not use VAbenefits48Age Distribution of Female VA Users and Non-users, 2017(in percent)Female Users19.52.811.116.121.319.65.6Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and Statistics20.5Female Veteran Non-Users23.521.718.09.3 9.73.5 2.35.21.418

Post-9/11 Gulf War era Veterans make up almost half of all female Veterans who use VA benefits andservices. Most male VA users served during either the Vietnam or Post-9/11 Gulf War era.Distribution of Male VA Users and Non-Users by Period of Service, 2017(in percent)Male Veteran Users32.8Male Veteran istribution of Male VA Users and Non-Users by Period of Service, 2017(in percent)Female UsersFemale Veteran Non-Users49.132.422.24.18.9 10.70.82.629.825.513.20.8Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and Statistics19

Data SourcesThe United States Veterans Eligibility Trends and Statistics (USVETS) is an integrated database of all living and deceased Veterans, including thosethat do not use any VA benefits. It is comprised of administrative records from the Veterans Benefit Administration (VBA), the Veterans HealthAdministration (VHA), the National Cemetery Administration (NCA), and the Department of Defense’s Defense Manpower Data Center, (DMDC).This integrated data is also augmented by commercial data sources include additional geographic and socio-economic information on the Veteranpopulation. VA program data are included in USVETS based on the following criteria:– Health Care: All Veterans who receive either VA inpatient care, VA outpatient care, purchased (fee basis) care, VA long-term servicesand support, or VA pharmacy care were included. VA Health Care enrollees who did not seek care from VA during the current yearwere not included. Veterans who only sought care from a VHA Vet Center were not included.–Compensation & Pension: All Veterans who receive monthly VA Disability Compensation or Pension payments were included. Veteranswho received Special Adaptive Housing benefits were also included in the analysis. Veterans with pending or denied claims were notincluded.–Education: All Veterans who received benefits for Chapter 30, 32, 33, 1606, and 1607 education programs were included.–Vocational Rehabilitation: All Veterans who participated in various stages of the Vocational Rehabilitation and Employment programwere included.–Loan Guaranty : All Veterans who have an active, new or re-financed VA-guaranteed home loan were included.–Life Insurance: All Veterans who have an active VA life insurance policy or were in receipt of a benefit from a policy that wasadministered or supervised by VA were included. VA insurance programs included in the analysis were National Service Life Insurance(NSLI), United States Government Life Insurance (USGLI), Veterans’ Special Life Insurance (VSLI), Veterans’ Reopened Insurance (VRI),Service-Disabled Veterans Insurance (S-DVI), Veterans’ Mortgage Life Insurance (VMLI), Traumatic Injury Protection (TSGLI), andVeterans’ Group Life Insurance (VGLI). The analysis does not include active Service-members and spouses/dependents who participatein Service-members’ Group Life Insurance (SGLI) and Family Service-members’ Group Life Insurance (FSGLI).–Memorial Affairs: All Veterans who were interred in a National, State, Interior, or Military cemeteries, or Veterans who were interredin private cemeteries and requested headstones/markers from VA were included. Due to data unavailability, Veterans who onlyreceived Presidential Memorial Certificates or a flag were not included.20

Methodology and Assumptions A Veteran user is defined as any Veteran who received or used at least one VA benefit or service during the fiscalyear. Veteran spouses, Veteran dependents, and active military service members who used VA benefits and serviceswere not included in the analysis. Each Veteran is only counted once in the overall total even if he/she used multipleprograms. VA uses a number of methods to uniquely identify Veterans in its data systems, including social security number(SSN), scrambled SSN (SCRSSN) in VHA, claim or file numbers in VBA, and Electronic data interchange personalidentifier (EDIPI) in DoD. Because each input source included SSN, records from each source were combined usingthe Veteran’s SSN as the primary identifier. Additional information on data integration can be found in USVETSTechnical Documentation. Veteran records from each input source were verified against official Social Security Administration data to validateSSN, name, date of birth, and gender. Missing SSN or SSNs determined to be incorrect by SSA were omitted from the analysis. Estimates for the number Veterans who did not use any VA benefits or services were defined as the differencebetween total population estimates from the Veteran Population Projection Model (VetPop) 2016 and the number ofVA users identified in USVETS. Non-users counts were adjusted to ensure total population estimates are consistentwith VetPop16.– The methodology used to validate Veterans’ records in USVETS was revised. Thus, the number of VA usersfrom 2008-2016 has been revised to reflect these changes. Some data elements were not available for all Veteran records. A minimum of 70% coverage for any particular dataelement was assumed to be an appropriate sample of all Veteran users to create frequency distributions. However,at the time of this release, we have not completed an assessment of any potential bias effects as a result of missingdata.21

Contact InformationDepartment of Veterans AffairsOffice of Enterprise IntegrationOffice of Data Governance and Analytics, National Center forVeterans Analysis and StatisticsFor questions, please email us at VANCVAS@va.gov22

Source: U.S. Veterans Eligibility Trends and Statistics, 2017 Prepared by the National Center for Veterans Analysis and Statistics Number of female Veteran users increased by 51.8% since 2008 while the total number of female Veterans increased by only 9.8% Number of female Veterans grew at an average

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