Introduction Although the benefits of employment for veterans with mental health conditions are well-known, the effect of veterans’ employment on a health system has not been evaluated. The purpose of this study was to evaluate the effect of veterans’ employment (versus unemployment) on subsequent health care utilization in the Veterans Health Administration (VHA). Materials and Methods This study used a sample of 29,022 veterans with mental health and substance use disorders who were discharged from VHA’s employment services programs between fiscal years 2006 and 2010. Veterans’ employment status (employed/unemployed) upon discharge from VHA employment programs was ascertained from program discharge forms and linked with VHA administrative health care utilization data for the subsequent 1- and 5-year periods. Results Multivariable ordinary least-squares and logistic regression models adjusted for site clustering and covariates indicated that employment (versus unemployment) predicted less health care utilization 1 year and 5 years post-discharge from employment services, including fewer outpatient mental health visits, homelessness services visits, employment services visits, primary care visits, and lower odds of mental health hospitalizations, mental health or vocational rehabilitation residential stays, and medical hospitalizations. Employment did not predict emergency department visits. Conclusions VHA’s investment in employment services for veterans with mental health and substance use disorders could reduce health care utilization system wide.

中文翻译：

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职业康复后的就业预测患有心理健康诊断的退伍军人的医疗保健利用率下降

简介 尽管就业对有心理健康问题的退伍军人的好处是众所周知的，但退伍军人就业对卫生系统的影响尚未得到评估。本研究的目的是评估退伍军人就业（相对于失业）对退伍军人健康管理局 (VHA) 后续医疗保健利用的影响。材料和方法 本研究使用了 29,022 名在 2006 至 2010 财年期间从 VHA 就业服务计划中退伍的心理健康和物质使用障碍退伍军人的样本。确定退伍军人从 VHA 就业计划退伍时的就业状况（就业/失业）来自计划出院表格，并与随后 1 年和 5 年期间的 VHA 行政医疗保健利用数据相关联。结果针对站点聚类和协变量调整的多变量普通最小二乘和逻辑回归模型表明，就业（相对于失业）预测就业服务出院后 1 年和 5 年的医疗保健利用率减少，包括门诊心理健康就诊、无家可归服务就诊次数减少，就业服务访问，初级保健访问，以及较低的心理健康住院、心理健康或职业康复住院和医疗住院的几率。就业并不能预测急诊科就诊。结论 VHA 在为患有精神健康和物质使用障碍的退伍军人提供就业服务方面的投资可能会降低整个医疗保健系统的利用率。