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Dr. Jean Yoon, PhD, a Health Economist in the Veterans Affairs Health Economics Resource Center and Adjunct Professor at the University of California, San Francisco, used inpatient discharge data from the Pennsylvania Health Care Cost Containment Council (PHC4) to support her study of veterans’ use of the US Department of Veterans Affairs (VA) and non-VA care. Dr. Yoon’s study, Health Care Access Expansions and Use of Veterans Affairs and Other Hospitals by Veterans, examined six years of hospitalizations for Veterans in Pennsylvania and four other states. The research team examined data to understand the services used.

The PHC4 hospitalization data was helpful to analyze which non-VA Pennsylvania hospitals veterans utilized. The researchers were able to observe the period before and after the Affordable Care Act (ACA) and the US Veterans’ Choice Act (VCA) of 2014 and investigate how these policies affected hospitalizations.

Dr. Yoon’s study was published in JAMA Health Forum.1 Hospitalization data was combined with VA enrollment records, VA acute hospital records, and state discharge data to examine changes in the use of VA and non-VA hospitals for veterans over a six-year period in five states, including Pennsylvania. Dr. Yoon stated, “Changes were found in the use of non-VA acute care after the ACA and Veterans Choice Program (VCP) were implemented.” She explained further, “After the VCA, veterans had more use of community hospitals and less use of VA hospitals. After the ACA, veterans had more hospitalizations covered by Medicaid.” The study states that the shift in hospitalizations to non-VA hospitals was not associated with changes in mortality after the VCA or Medicaid expansion.

Dr. Yoon plans to investigate differences between hospitals in future work and will assess other outcomes to understand how changes in hospital utilization associate with quality of care. She relayed that the process to request data through PHC4’s Special Requests department was easy to navigate, and the data were helpful to her project. She recommends using PHC4 data for researchers who want to examine hospitalizations in Pennsylvania.


1 Yoon J, Kizer K, Ong M. Health Care Access Expansions and Use of Veterans Affairs and Other Hospitals by Veterans. JAMA Health Forum. 2022;3(6)

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