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Military Health Care a Top Topic at DACOWITS' Base Visits

By Gerry J. Gilmore
American Forces Press Service

WASHINGTON, May 12, 2003 – TRICARE, the U.S. military's health care system, is much improved, but some beneficiaries still have difficulty understanding and accessing the system.

That's one message the Defense Advisory Committee on Women in the Services delivered May 8 to Charles S. Abell, principal deputy undersecretary of defense for personnel and readiness, during two days of committee business meetings here.

The DACOWITS chairwoman, retired Marine Lt. Gen. Carol G. Mutter, noted during the meetings that the advisory committee had recently visited some stateside military installations, with overseas trips planned as well.

This year, Mutter pointed out, DACOWITS is focused to examine three areas: women's health care, particularly obstetrics-gynecology; military women's retention issues; and military deployment issues.

Things were better than they used to be regarding TRICARE, DACOWITS members emphasized to Abell. However, they added, there appeared to be communication problems among beneficiaries chiefly involving junior enlisted families and understanding the types of services the system offered and how to access them.

Abell acknowledged that TRICARE "is an extremely complex health care system."

However, he emphasized, that the military's health care system, which is patterned after civilian-sector health maintenance organizations, "is the only nationwide managed care system that exists."

Therefore, Abell continued, TRICARE's sheer size and myriad rules makes it "tough to navigate" for many beneficiaries.

"Not only does it have all the rules that go with running a good managed care system," he pointed out, "it has all the rules of government attached to it as well."

This can make understanding TRICARE "tough," Abell remarked. However, he noted that customer-service improvements would likely be implemented since a new set of TRICARE contracts is being readied.

Increased emphasize would be put on "customer orientation" for the TRICARE system, he said. Abell also told committee members DoD wants "to optimize" business at its military hospitals and clinics.

"We want to bring in more (military health care) beneficiaries into our facilities," he said, noting, "It's frankly, cheaper it's just good business."

Also, military health care professionals "need to do as much work as they can" in military facilities, he explained, "so that they are ready to go do that kind of work if they have to deploy to (places like) Iraq or Afghanistan."

For example, Abell explained, "if there's a family member out there who needs a cardiac operation, we'd like to be able to do that to keep our surgeons ready." Currently, he pointed out, about one-third of military health care is accomplished "in-house" at military medical facilities.

DoD isn't standing still in improving quality of health care for military beneficiaries and their families to include obstetrics- gynecological patients, Dr. David Tornberg noted during a February interview with American Forces Press Service.

Obstetrics beneficiaries have asked for a variety of benefits and changes, Tornberg, deputy assistant secretary of defense (Health Affairs) for clinical and program policy, remarked. He noted DoD has listened to and is now acting upon those concerns.

"We've taken those to heart," he emphasized, "and incorporated them into an improved OB program." He noted that prospective mothers have asked for better communications between patients and health care providers. To address this request, he explained, military officials are working to establish "a team approach" to the delivery process.

For example, Tornberg explained, mothers-to-be will see the same group of providers consistently over the course of a nine-month pregnancy. This, he pointed out, should improve the comfort level of prospective mothers. Also, the OB appointment-making process will be made more efficient, and patients' access to gynecological specialists will be improved, Tornberg said.

And Tornberg's boss, Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs, told Pentagon reporters April 29 that DoD is transforming its military health care system to make it more efficient and responsive to the needs of beneficiaries. This, he noted, involves evaluating the quality and performance of military health care via a "scorecard" system.

"We looked at the thrust of why we do what we do and what we wanted to do to improve the system," Winkenwerder explained. He pointed out that the new program contains 25-30 separate initiatives designed to improve and promote: quality of care and customer satisfaction, military medical readiness, and efficient use of resources.

Another concern that cropped up during DACOWITS' military installation visits was the availability and cost of childcare for service member families, committee members told Abell.

He said that DoD has requested supplemental funding from Congress to expand military childcare center hours and to offset some of the costs.

DACOWITS members also told Abell that thousands of active duty and reserve service members -- of both genders -- have been or still are separated from their families back home while supporting Operation Iraqi Freedom and other military operations in recent months.

"We're certainly very interested in what the impact of the deployments are on the (military) families and how that will manifest itself on retention," Abell remarked, noting that DoD is now working on a "lessons learned" report on recent military deployments.

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