Summary: The Ministry of Defence (the Department) needs to recruit around 20,000 men and women each year to the Armed Forces. The Department draws its workforce from a broad section of society including from areas of high unemployment and people with few qualifications. Recruits are required to adapt to military life and ethos and, where it is essential, give up a few of the freedoms they enjoyed as civilians. In order to equip personnel with the necessary skills and attitudes for the full spectrum of military operations including war fighting, the Services instill a culture of discipline; reliance on others; and acceptance of orders. Although Armed Forces personnel can have a long, fulfilling career, the majority of them will leave the Armed Forces at least 25 years before the current national retirement age and will need and wish to pursue a full second career. The Department believes that “a robust and effective system of resettlement provision is a fundamental pillar of personnel support and a tangible manifestation of the Armed Forces’ commitment to be an employer of first choice”. Such provision should allow military personnel to serve secure in the knowledge that they will receive assistance to prepare them for life and future employment when they leave the Services. Of course, much of the ultimate responsibility for a successful return to civilian life rests with the individual Service Leaver who needs to exploit the opportunities offered by the Department’s resettlement provision.
Abstract: Background: Enactment of the Veterans Choice Act (VCA) in 2014 and expansion of Medicaid programs led to greater options for Veterans to receive health care outside of the U.S. Department of Veterans Affairs (VA). However, little is known about how much care women Veterans receive in VA or non-VA settings paid by VA or other insurance types. We explore trends in inpatient care received by women Veterans before and after implementation of the VCA, focusing on hospitalizations, as these patients are often higher risk. Methods: Data for women Veterans were linked to hospital discharge data for 2013-2017 from 11 diverse states. Patient and hospital characteristics by VA and non-VA payer and age group (less than 65 years and 65 years and older) were compared for acute hospitalizations in Pearson's chi-square and analysis of variance tests. We compared the odds of a hospitalization occurring before and after VCA implementation for each specific setting/payer using separate logistic regressions. Results: Our sample included 117,177 acute medical/surgical hospitalizations. For younger women, the most common hospital setting/payer was VA hospitals (36%); older women most frequently received hospital care in non-VA hospitals covered by Medicare (61%). After the VCA, the probability of receiving VA-purchased care increased significantly for older women only. Younger women saw a significant decrease in VA hospitalizations post-VCA. Conclusions: We found that after multiple expansions in non-VA health care options, women Veterans sought more VA-purchased community hospital care.