from AUSA 's Institute of Land Warfare

MILITARY HEALTH CARE IN TRANSITION

The long-established ways of providing medical care can also be provided to family members. If care is not for soldiers, militaty retirees, and family members are available or the family member does not live near a mili­ changing. The bond with career soldiers for lifetime tmy clinic, a statement of nonavailability will be issued, medical care - though not an entitlement in law- is authorizing use of CHAMPUS. When on extended ac­ being redefined. The historic promise of free lifetime tive duty, reserve component soldiers and their families medical care is coming face to face with the fiscal reali­ will receive the same health care as active duty soldiers ties of the post-Cold War era. and families.

During the Cold War, the Defense Department main­ In this resource-constrained environment, a militmy tained a large medical infrastructure of personnel and retiree and family members, not yet eligible for Medi- facilities. Providing health care, may recetve space­ care for service members available care in a military The bond with career soldiers for life-time (and for families and retir­ clinic or hospital. If care is medical care ... is being redefined. ees on a space-available unavailable at the militaty fa- basis) was a means to cility or the patient lives too maintain medical skills and readiness. It also fulfilled far away, the retiree or family member will have to ob­ the promise of continuing medical care to retirees. tain care through CHAMPUS.

In the post-Cold War era, militaty medical resources When the militaty retiree or family member becomes are more constrained. The continuing reduction of the eligible for Medicare, space-available care in a militaty militaty medical system of doctors, nurses, medical tech­ facility may not be an option. This is because of a fed­ nicians and associated hospitals and clinics is having an eral regulation that blocks Medicare from reimbursing impact on the availability of medical care to the total militaty facilities for treating Medicare-eligible patients. military population. Space-available care will become In the absence of reimbursement, Medicare-eligible ben­ less common as medical staffingand facilities decrease. eficiaries (and other space-available beneficiaries) will probably receive less care in the DoD medical system More than 1. 7 million active duty service members simply because DoD cannot afford the additional re­ will continue to receive health care on a first-priority sources. Further complicating the situation, the Medi­ basis at hospitals and clinics operated by the Depatt­ care-eligible retiree is not eligible for alternative care ment of Defense. As long as there are sufficient num­ under CHAMPUS (or the successor program, bers of physicians assigned at the medical facility, care TRICARE).

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DEFENSE REPORT is published by the Association of the United States Army's Institute of Land Warfare. The series is designed to provide information on topics that will stimulate professional discussion and further public understanding of the Army's role in national defense. Questions regarding the DEFENSE REPORT should be directed to: AUSA, Institute of Land Warfare (Attn: DEFENSE REPORT), 2425 Wilson Blvd. Arlington, VA 2220 I.

February 1996/DR96-2 The most significantchange in military health care is is needed for military requirements is still an open ques­ the introductionofTRICARE, DoD's regional managed tion. care program. Individuals eligible for CHAMPUS are eligible for TRICARE. The change has begun in se­ From this brief discussion it is obvious that military lected areas of the United States and is scheduled to be medical care, and health care in general, is in a state of fully operational in the continental United States and transition. Any changes that are promulgated will affect Hawaii by 1997. Alternative managed care programs the readiness of the medical departments of the armed are being pursued in Alaska, Europe and the Pacific. forces and the more than 8 million men, women and children who are eligible for care. TRICARE offers three options for the receipt of health care. TRICARE Standard is CHAMPUS under Currently, several outcomes appear inevitable: another name. TRICARE Extra is a variant of CHAMPUS and offers the advantage of a network of • Health costs for beneficiaries will increase as gov­ health care providers who accept a reduced CHAMPUS ernment resources become more constrained. payment in return for the business the local military fa­ cility refers to them. TRICARE Prime is the managed • There will be fewer medical personnel in uniform care or health maintenance organization (HMO) option. and fewer military medical facilities as the armed Its focus is on enrolling beneficiaries with a primary care forces are reduced in size and bases continue to be manager (the military hospital or clinic or a network closed. Access to military hospitals and clinics will provider). become more difficult.

Serious and concerned individuals within and out­ • There is little likelihood that military facilities will side DoD are watching TRICARE very closely. Con­ be reimbursed in the near term for treating Medi­ gress, as well as the Defense Department and associa­ care-eligible beneficiaries. tions such as AUSA, will be examining TRICARE as it evolves. • Congress will examine TRICARE closely; alterna­ tives toTRICARE will be considered if problems of In light ofthe resource-constrained militarymedical access and cost escalate and TRICARE is unable to system, some elements in DoD, the recent Commission provide a uniform benefit. on Roles and Missions of the Armed Forces, the Gen­ eral Accounting Office and the Congressional Budget Where does this leave the military beneficiary? Office have asked if the military medical departments should be providing peacetime health care to anyone In response to the recommendation of the Commis­ other than active duty service members. Some would sion on Roles and Missions of the Armed Forces, DoD scale down medical department personnel by up to 50 is examining medical readiness and health care benefits. percent, a level believed sufficientto provide peacetime At the same time, Congress is seeking ways to reduce soldier care and wartime casualty care. There would be health care costs in federal medical programs as part of corresponding cuts in hospitals and clinics. the effort to reduce the federal budget deficit. It is there­ fore incumbent on all beneficiaries to be well informed The surgeons general of the military services have of the various alternatives being proposed and to assess testifiedthat if the military medical departments are cut realistically their impact. Proposals for change are not to meet only wartime needs, the armed forces would inevitable; each of us must enter into the debate to en­ have great difficultyrecruiting and retaining physicians, sure that the consequences of each proposal are aired surgeons, physicians' assistants, technicians, nurses and and the direct and indirect effects on the armed forces other specialists. What size military health care system are brought out for open debate.

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