Research for Formals

The TRICARE program is designed to provide for the health care needs of those on active duty, their family members, and retirees and their family members. TRICARE is a complicated health care system with several different parts. One key component is Prime, the managed care portion of the Defense Health Plan (DHP). One must enroll in Prime in order to receive care under it; however, other options for receiving care do not require enrollment. This study responds to tasking from the Under Secretary of Defense (USD) for Personnel and Readiness concerning the feasibility of an enrollment system for the DHP. Under Prime, enrollment is a requirement for receiving care. In a limited sense, enrollment is not only possible but currently under way. We believe, however, that the more important question and one posed under the tasking is whether universal enrollment is feasible. As we'll show, Prime pertains to a relatively important and growing part of the beneficiary population that relies on military treatment facilities (MTF)-military clinics and hospitals-for health care. The other user of the MTFs rely on space-available care. These people don't have to enroll to use military healthcare providers or facilities; they use the NTFs for care when there is sufficient capacity.

The Department of Defense (DOD) is working with the Department of Health and Human Services (DHHS) to develop for its Medicare-eligible beneficiaries a cost-effective alternative for delivering access to quality care. This alternative, commonly called TRICARE Senior Prime, will give Medicare-eligible beneficiaries the opportunity to enroll in Prime with primary care managers (PCMs) at military treatment facilities (MTFs). TRICARE Senior Prime enrollees will have the same priority access to MTF as military retirees and retiree family members currently enrolled in Prime. At present, this program is in the demonstration phase. DOD should be concerned that many managed care plans have either withdrawn from the Medicare-Choice program entirely or reduced their service areas in the last several years as the Medicare-Choice plan has been phased in. The purpose of this report is to determine what factors have played a part in these withdrawals and how this could affect the viability of the TRICARE Senior Prime program.

To better understand the utility of AOEs in peacetime, we wanted to learn how much business they do as CVBG station ships and who their customers are during forward deployment. To that end, in 1996 we asked the Navy to have deploying AOEs record their underway replenishment (UNREP) data and send it to CNA. We supplemented those data with similar AOE and substitute CVBG station ship data. This report documents the UNREP activity of the AOEs (and substitute CVBG station ships) when they are deployed. (It doesn't reflect the total logistics support Navy combatants receive from all sources.)

We report on a few publications that present quantitative conclusions on the impact of aging platforms on maintenance and operating costs. This literature review, though far from exhaustive, is meant to convey the idea that this topic has been examined before, and that work in this area is continuing. Some exploratory analysis of two data sets that were created for this purpose is presented. Both use the individual aircraft as the unit of Observation. One is organized around individual sorties in a particular month; the other contains summary maintenance labor data and is organized by aircraft, by month, for a 10-year period. Both provide additional evidence that maintenance effort raises with aircraft age.