Rising disability payments led to fewer hospitalizations for Vietnam veterans with diabetes, a study led by Dr. Amal Trivedi at Providence VA Medical Center found. In 2001, a VA policy change increased disability payments for Vietnam veterans with diabetes. Researchers looked at 14,000 Vietnam veterans eligible for these payments and found they had a 21% reduction in hospitalizations, compared to a control group. However, they did not experience lower mortality rates as a result of increased compensation. The researchers concluded, “Disability awards can have important health benefits for veterans.
The results appeared on June 13, 2022, in the magazine JAMA internal medicine.
Lower income linked to poorer health
In 2001, VA made diabetes a presumptive condition for disability compensation. Veterans who served with “boots in the field” in Vietnam, Cambodia and Laos during the Vietnam War were eligible. The decision was based on a medical institute report who found a possible association between Agent Orange exposure and diabetes.
Previous research has shown that people with lower incomes generally have poorer health and die earlier than those with higher incomes. Although income has been linked to health, less is known about how VA disability payments directly affect veterans’ health. Most previous studies have focused on the effect of disability compensation on things like veterans’ employment decisions, rather than direct health outcomes.
To fill this knowledge gap, the researchers looked at data from more than 70,000 Vietnamese-era veterans with diabetes. Of these, more than 14,000 were eligible for diabetes compensation under the 2001 policy change.
Higher compensation and fewer hospitalizations after policy change
According to the study, veterans newly eligible for disability compensation experienced “marked reductions” in hospitalizations after the policy was adopted, compared to those who were not eligible. In the diabetes group, hospitalizations decreased by 10% soon after the policy change. This same group had a 21% reduction in hospitalizations in 2018, the end of the study period.
Under the new policy, eligible veterans received more than $17,000 more in annual disability awards by 2018, compared to ineligible veterans.
These increased payments could improve economic factors that affect veterans’ health, according to Trivedi. “By providing a stable source of income, disability compensation could make the difference between access to stable housing, access to food or prescribed medication,” he said. “These are things that can help keep veterans out of the hospital.”
Although policymakers may be concerned about the cost of an increase in disability compensation, the researchers pointed out that their findings suggest that the cost of increased disability payments may be offset by a reduction hospital visits and associated costs. Trivedi explains, “As policymakers consider potential changes to veterans’ disability compensation programs, we offer evidence that compensation payments significantly reduce veterans’ hospitalizations, especially those funded by the ‘Health Insurance. This means that disability compensation can generate significant reductions in public spending on hospital care.
The study also found that the link between disability payments and fewer hospitalizations was not affected by race or ethnicity, socioeconomic status, or other health conditions.
Disability award not linked to lower mortality rate
Lower hospitalization rates did not translate into lower death rates among the veterans in the study, the researchers said. Annual mortality rates were similar in the study group, regardless of eligibility for diabetes compensation.
The researchers suggested several possible explanations for why death rates did not decline with hospitalizations. This could be because VA is an equal access health care system. The link between low income and poorer health and death could be caused by a lack of adequate health insurance, which is less problematic in the VA system. Additionally, the health benefits of higher income may be less evident in middle-aged or older adults, affecting younger age groups more.
Although higher disability benefits did not lead to a significant decrease in the death rate, the death rates were similar in the two groups of veterans. This led the researchers to conclude: “The lack of mortality difference despite large and sustained compensation should temper expectations that increasing incomes of middle-aged and older adults will invariably improve life expectancy.” .
The researchers went on to note that while previous evidence suggests that disability compensation was associated with lower employment rates for veterans, the study “should reassure policymakers that the Exit of veterans from the labor market was not associated with an increased risk of mortality”.
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