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Evolution of the Military Healthcare System

/analyses/2000/evolution-of-the-military-healthcare-system

In recent years, as the military medical departments have imple­ mented the legislatively mandated TRICARE program, the benefi­ ciary population has voiced concerns regarding the perceived deterioration of its health benefit. The military medical departments also have expressed concerns, but of a different nature, relating to Congress's enhancement of the benefit over time without the provi­ sion of appropriate funds to support the changes. The Navy believes that it can prepare more informed future budget strategies by care­ fully examining the evolution of the current military health care ben­ efit and determining the implications of these changes on overall health care costs. In this paper, we document the legislative and regulatory evolution of the military health care benefit since 1956-the year that Congress originally authorized the offering of civilian health care coverage to active duty dependents. We also determine the extent to which major changes in the benefit have contributed to changes in program costs. We begin our analysis with an overview of the initial, contemporary, military health care benefit (or baseline benefit) as authorized by Congress. Next, we focus on the specific changes to the benefit that have affected the following features over time: who is eligible for cov­ erage, the range of covered services, the rate of payment for health services, and program administration. Finally, we examine military health care program costs over time to determine the extent to which major program changes have affected costs.

Evolution of the Military Healthcare System The Evolution of the Military Health Care System: Changes in Public Law and DOD Regulations In recent years, as the military medical departments have imple ... that it can prepare more informed future budget strategies by care­ fully examining the evolution of the current military health care ben­ efit and determining the implications of these changes on overall health care costs. In this paper, we document the legislative and regulatory evolution of the military health care benefit since 1956-the year that Congress originally authorized the offering

Eric Trabert

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Eric Trabert is a CNA expert in all-hazards preparedness with a focus on public health and health care emergency preparedness and response.

Trabert-Eric Eric Trabert is a CNA expert in all-hazards preparedness with a focus on public health and health care emergency preparedness and response. /images/Experts/Trabert-Eric.webp Eric Trabert is an expert in all-hazards preparedness with a focus on public health and health care emergency preparedness and response. He provides strategic leadership for CNA's public health practice ... . Prior to joining CNA, Trabert conducted operations research for hospitals and health systems to identify best practices in the delivery of clinical care. Trabert received a Master of Public Health

Center for Public Health Preparedness and Resilience

/centers-and-divisions/ipr/phpr

Helps HHS and other public health agencies and organizations develop and test emergency policies, plans, and operational capabilities.

the public health and health care systems they rely on daily and in times of crisis. left small standard green white gray /centers-and-divisions/ipr/phpr/vaccination-tool none image half /images ... and outreach.  Pulse: Wastewater Surveillance https://vimeo.com/521552795 none orange half Pulse: Wastewater Surveillance Risk Assessment We help public health agencies and health care organizations ... Health Preparedness and Resilience  helps clients develop, implement, assess and enhance public health and health care emergency preparedness programs. We do this through innovative and customized

HEALTH ANALYTICS AND MEDICAL READINESS TEAM

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CNA’s Health Analytics and Medical Readiness (HAMR) team is comprised of analysts and experts whose skills span health care policy, clinical decision-making, biostatistics and epidemiology, and population health. Due to the complexity of public health issues, we take an interdisciplinary approach to understand critical health care issues as well as the associated impacts on personnel, finances, and public safety.

HAMR-4-pager CNA’s Health Analytics and Medical Readiness (HAMR) team is comprised of analysts and experts whose skills span health care policy, clinical decision-making, biostatistics and epidemiology, and population health. Due to the complexity of public health issues, we take an interdisciplinary approach to understand critical health care issues as well as the associated impacts on personnel, finances, and public safety. CNA’s Health Analytics and Medical Readiness (HAMR) team is comprised of analysts and experts whose skills span health care policy, clinical decision-making

James Alexander

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, including health care and outpatient mental health care. His specialty is leadership, training, and managing complex operations. His private work in healthcare settings has focused on restructuring, process ... health care companies where he was asked to restructure and scale private healthcare operations with multi-site management. Alexander has a Master of Arts degree in administrative service ... with providing subject matter expertise to the Jails and Justice Support Center for the U.S. Department of Justice.  Prior to joining CNA, Alexander was a deputy warden and coauthored an interim care mental

COVID19 AND THE SAFETY OF SEAFARERS

/analyses/2020/10/covid19-and-the-safety-of-seafarers

Seafarers are an integral, if often overlooked, workforce, people who are essential both to individual communities and to the global economy. From navies and coast guards, to commercial industries such as fishing, shipping, and tourism, a healthy and valued workforce at sea is central to global stability. The COVID-19 pandemic and its unintended side effects across the blue economy have disproportionally hit seafarers, from those lacking ready access to medical care at sea, to those suffering economic damages while stranded ashore. Port state obstacles to crew rotations, isolation due to COVID-19 social distancing guidelines, restricted shore leave, extended contracts, and erratic port state guidance directly endanger mariners’ livelihoods and their mental health. The COVID-19 pandemic has underscored how readily these frontline workers can slip out of view. Mariners face immediate health risks from COVID-19 exposure, risks similar to those faced by nurses, delivery drivers, and grocery store clerks, but often serve without the dignity and resources that can come with being formally deemed essential. Yet efforts to safeguard mariners from COVID-19 differ depending on industry, in many cases with cost and risk falling squarely on the mariners themselves. What emerges from this network of interlocking risks is the need for robust action across every stakeholder group—including the public—to safeguard seafarers and society while promoting dignity and stability for a critical workforce. This policy paper, reflecting ongoing work by CNA to understand these risks to mariners, is meant to contribute to a global conversation on the risks mariners face and some of the steps necessary to protect and sustain these vulnerable workers and the societies that rely upon them.

face immediate health risks. Across maritime sectors, an infection onboard can race through tightly packed crews who have limited ready access to medical care. For example, nearly 1,000 sailors tested ... . The COVID-19 pandemic and its unintended side effects across the blue economy have disproportionally hit seafarers, from those lacking ready access to medical care at sea, to those suffering economic damages ... directly endanger mariners’ livelihoods and their mental health. The COVID-19 pandemic has underscored how readily these frontline workers can slip out of view. Mariners face immediate health risks from

Linda Pikulin

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Linda Pikulin is a CNA expert in Military Health System data.

Pikulin-Linda Linda Pikulin is a CNA expert in Military Health System data. /images/Experts/Pikulin-Linda.webp Linda Pikulin is an expert in Military Health System data, including the use of clinical data to evaluate psychological health care and develop Navy medical force manning requirements. As human subjects review coordinator for the Center for Naval Analyses, she advises and supports ... , clinical informatics, and increasing the operational roles of Navy family nurse practitioners. She was also study director for the Psychological Health Risk-Adjusted Model for Staffing (PHRAMS

Anna Richey

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Anna Richey specializes in public health preparedness at CNA, focusing on improving population health outcomes and emergency preparedness capabilities.

Richey-Anna Anna Richey specializes in public health preparedness at CNA, focusing on improving population health outcomes and emergency preparedness capabilities. /images/Experts/Richey-Anna.webp Anna Richey specializes in public health preparedness, focusing on improving population health outcomes and emergency preparedness capabilities through strategic planning, response operations and data-driven analyses. At CNA, she has supported public health preparedness exercises, real-world response efforts, after-action analyses and various grant management functions at the federal, state

The Quality Volume Relationship: Comparing Civilian and MHS Practice

/analyses/2014/the-quality-volume-relationship-comparing-civilian-and-mhs-practice

The literature shows that the best outcomes occur when patients get their health care in high-volume settings. High-volume surgeons are more proficient. High volume hospitals are safer. These findings have changed how civilian health care is delivered. Civilian hospitals, insurance companies, governments, and institutions all focus on volume as an indicator of quality. The Military Health System (MHS) lags by comparison. Fewer MHS patients have their procedures in high-volume settings. MHS also misses opportunities to consolidate low-volume hospitals into higher-volume regional facilities. For many product lines, most operations are done by surgeons who perform the procedure infrequently. There are nearly 10 million TRICARE beneficiaries, and thus ample opportunities for MHS to set up high-volume "center of excellence" programs to meet existing beneficiary demand for services. Such initiatives could improve average patient outcomes while supporting clinical currency for MHS physicians.

patients get their health care in high-volume settings. High-volume surgeons are more proficient. High volume hospitals are safer. These findings have changed how civilian health care is delivered. Civilian hospitals, insurance companies, governments, and institutions all focus on volume as an indicator of quality. The Military Health System (MHS) lags by comparison. Fewer MHS patients have ... the Military Health System (MHS) according to the standards in the quality-volume literature. We start with a literature review of recent quality-volume studies to identify current accepted volume targets

Sarah Tidman

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Sarah Tidman is a CNA expert in emergency management, public health, and medical issues and preparedness activities.

Tidman-Sarah Sarah Tidman is a CNA expert in emergency management, public health, and medical issues and preparedness activities. /images/Experts/Tidman-Sarah.webp Sarah Tidman is an expert in emergency management, public health, and medical issues and preparedness activities. She specializes in designing and evaluating preparedness exercises for all levels of government and has deployed to observe and evaluate real-world response operations. As the program manager for CNA's work with the U.S. Department of Health and Human Services and the Assistant Secretary for Preparedness and Response