Policymakers and analysts have raised concerns about DoD's rising health care costs, the quality of care provided at its facilities, and how well the department's medical establishment prepares for wartime missions. Efforts to change the system are complicated, however, partly because the resources used to accomplish the various goals are often intermingled or unclear. For this report, the Congressional Budget Office examined several broad, illustrative approaches that might address policymakers' concerns. In addition, the agency estimated the costs of two options that have been proposed specifically to make changes to TRICARE.
Problems stemming from the misuse and abuse of alcohol and other drugs are by no means a new phenomenon, although the face of the issues has changed in recent years. National trends indicate substantial increases in the abuse of prescription medications. These increases are particularly prominent within the military, a population that also continues to experience long-standing issues with alcohol abuse. The problem of substance abuse within the military has come under new scrutiny in the context of the two concurrent wars in which the United States has been engaged during the past decade-in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom and Operation New Dawn). Increasing rates of alcohol and other drug misuse adversely affect military readiness, family readiness, and safety, thereby posing a significant public health problem for the Department of Defense (DoD). To better understand this problem, DoD requested that the Institute of Medicine (IOM) assess the adequacy of current protocols in place across DoD and the different branches of the military pertaining to the prevention, screening, diagnosis, and treatment of substance use disorders (SUDs). Substance Use Disorders in the U.S. Armed Forces reviews the IOM's task of assessing access to SUD care for service members, members of the National Guard and Reserves, and military dependents, as well as the education and credentialing of SUD care providers, and offers specific recommendations to DoD on where and how improvements in these areas could be made.
Contents: Recent Developments; Background; Subjects: Purpose of DoD¿s Military Health System (MHS); Structure of the MHS; Unified Medical Budget; Medicare Eligible Retiree Health Care Fund; Cost of Military Health Care to Beneficiaries; Changes in MHS in Recent Years; Eligibility to Receive Care; Assignment of Priorities for Care in Military Medical Facilities; Relationship of DoD Health Care to Medicare; Military Personnel and Free Medical Care for Life; Payment of Private Health Care Providers; Effect of Base Realignment and Closure on Military Medical Care; Pharmacy Benefit; Medical Benefits Available to Reservists; Congressionally Directed Medical Research Program; Tricare and Abortion; and Use of Animals in Medical Res. or Training.
In 2012, the Department of Defense (DoD) spent $52 billion on health care for service members, retirees, and their families. The department offers health care to nearly 10 million people through its TRICARE program, an integrated system of military health care providers and regional networks of civilian providers. Established in 1993, TRICARE now consists of three major plans: TRICARE Prime, TRICARE Standard, and TRICARE Extra. The cost of providing this care has increased rapidly as a share of the defense budget over the past decade, outpacing growth in the economy, growth in per capita health care spending in the United States, and growth in funding for DoD's base budget. This book focuses on the approaches that can be taken to reduce federal spending on military care, and continues to provide information on management practices available to help achieve efficiencies within the military health system.
This monograph examines the feasibility of a new model for maintaining the clinical skills of the military medical force. Under the model, active-duty personnel would be assigned to civilian settings during peacetime. The study on which this monograph is based explored the feasibility of this model from a civilian perspective, focusing on civilian receptiveness to the proposed arrangement and identifying potential barriers and concerns. The study found that civilian medical organizations are generally receptive to the idea of such a model and that DoD could consider conducting a pilot study to assess the effectiveness of the model in improving military medical readiness.
The cost of providing that care has increased rapidly as a share of the defense budget over the past decade, outpacing growth in the economy, growth in per capita health care spending in the United States, and growth in funding for DoD's base budget (which finances the department's routine activities but has excluded funding for operations in Iraq and Afghanistan). Between 2000 and 2012, funding for military health care increased by 130 percent, over and above the effects of overall inflation in the economy. In 2000, funding for health care accounted for about 6 percent of DoD's base budget; by 2012, that share had reached nearly 10 percent. By 2028, health care would claim 11 percent of the cost of implementing DoD's plans, the Congressional Budget Office (CBO) estimates (see Summary Figure 1). The Budget Control Act of 2011 (as modified by subsequent legislation) capped funding for national defense between 2014 and 2021 at about 10 percent below CBO's projection of the cost of DoD's plans as of November 2013, using DoD's estimates of prices.1 The share of health care costs in future budgets will depend on how DoD adjusts its plans to comply with those caps. For example, if the growth in health care costs is unconstrained by new policies and cuts are made in funding for other defense activities (such as the development and procurement of weapon systems), then health care costs could account for an even larger percentage of the department's future spending.
Nearly 1.9 million U.S. troops have been deployed to Afghanistan and Iraq since October 2001. Many service members and veterans face serious challenges in readjusting to normal life after returning home. This initial book presents findings on the most critical challenges, and lays out the blueprint for the second phase of the study to determine how best to meet the needs of returning troops and their families.
This thesis is a qualitative analysis of the managed care approach to delivering health care in the Tidewater area of Virginia. The thesis begins with the development of civilian health care as well as the history of Navy and military medicine. This is followed by the development of managed care within the Department of Defense. A sociotechnical systems approach is then used to analyze the central function of accessing health care through the TRICARE service Center in the Tidewater area. The analysis disclosed some key deviations from providing the patient quick, dependable access into the military health care system. To control these variances, the establishment of horizontal coordination and communication linkages are recommended.
Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq. Shortly after troops started returning from their deployments, some active-duty service members and veterans began experiencing mental health problems. Given the stressors associated with war, it is not surprising that some service members developed such mental health conditions as posttraumatic stress disorder, depression, and substance use disorder. Subsequent epidemiologic studies conducted on military and veteran populations that served in the operations in Afghanistan and Iraq provided scientific evidence that those who fought were in fact being diagnosed with mental illnesses and experiencing mental healthâ€"related outcomesâ€"in particular, suicideâ€"at a higher rate than the general population. This report provides a comprehensive assessment of the quality, capacity, and access to mental health care services for veterans who served in the Armed Forces in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn. It includes an analysis of not only the quality and capacity of mental health care services within the Department of Veterans Affairs, but also barriers faced by patients in utilizing those services.
