Research for Health Care Issues

CRM D0003492.A1/Final The FY 2000 Evaluation of the TRICARE Program was performed jointly by the CNA Corporation and the Institute for Defense Analyses (IDA) for the Office of the Assistant Secretary of Defense (Health Affairs). The objectives of the evaluation were to assess (1) the effectiveness of the TRICARE program in improving beneficiaries' access to health care, (2) the impact of TRICARE on the quality of health care received by Military Health System (MHS) beneficiaries, and (3) the effect of TRICARE on health care costs to both the government and MHS beneficiaries. This documents represents the Center for Naval Analyses' contribution of the Evaluation of the TRICARE Program, FY 2000 Report to Congress. The full report also included IDA's evaluation of the costs to the government and beneficiaries. The TRICARE evaluation project is an ongoing effort that provides an annual report to the Congress as the program matures.

Navy medicine has identified mental health as one of the major product areas in which it wants to develop a business strategy that supports the effective and efficient provision of these services to the military health system's beneficiaries. To develop this strategy, the Navy Bureau of Medicine has established a mental health product line executive panel. It's members include both medical and non-medical Navy and Marine Corps personnel, reflecting the Navy's diverse mental/behavioral health resources. Among the many tasks facing the panel is establishing a comprehensive baseline understanding of mental/behavioral health care services as they currently exist in the Navy and Marine Corps communities. Our purpose in this document is to provide an overview of the regional TRICARE mental health care delivery systems and to identify issues requiring further investigation, thought, and analysis during the course of the executive panel's proceedings. This annotated briefing represents the first in a series of research documents that we will be preparing for the working group during the next several months.

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.

This briefing examines the rising number of youth smoking in the United States, the effects smoking has on bootcamp performance, the success of cessation programs in the military, and proposes several ideas for future research. The report argues that because of the large numbers, captive audience, and collection of useful data, bootcamp provides a unique setting for testing smoking intervention strategies. The briefing concludes by addressing the problems the military exchanges will face if a substantial federal tax on cigarettes becomes law. DTIC AD-A360279