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Top Doc Diagnoses Health Care

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Jan. 24, 1997 – DoD's health plan must avoid the shortcomings and legitimate criticisms of civilian managed care programs, DoD's top doctor warned defense health care providers.

"Place yourself in the shoes of your customer -- both beneficiary and line commanders," Dr. Stephen Joseph, assistant secretary of defense for health affairs, told TRICARE '97 Conference attendees here. "Ask yourselves, 'What can we, as hospital commanders, as physicians, as administrators, as nurses do to better serve our customers?'

"Progress in the enhancement of our ability to meet our readiness responsibilities is matched by TRICARE's continued growth and maturity," Joseph said. "TRICARE today is widely recognized as the military health care program. TRICARE tomorrow will be a finely honed, cooperative effort between the military and civilian sector built on uniform concepts oriented toward full customer satisfaction."

While TRICARE has matured, Joseph said, it isn't perfect. The one area of improvement he said he's most interested in is patient access to care.

"We have made great strides in breaking down the barriers to care, and our patients have noticed it," he said. He cited preliminary feedback from a regional patient survey that indicates high satisfaction with the health care plan. But survey data also suggests access, particularly in making appointments, remains problematic, he said.

"Right now, most of our facilities do not operate in the evening hours or over the weekend," he noted. "We must consider ways of changing that -- to offer our patients access to the care they need, when it is convenient for them."

Joseph included retirees in the access equation, citing his hopes for full access by Medicare-eligible retirees. "Our ultimate goal -- and we will keep driving at this -- is to enroll these beneficiaries in TRICARE Prime [DoD's managed care option]," he said. However, to realize this and other competing priorities, he said, DoD must "effectively and fully use our capacity and our resources, in creative ways, to satisfy the health needs of our entire beneficiary population."

Joseph challenged the military medics to provide their patients not only quality medicine but compassion.

"Last year from this podium, our very good friend Adm. [Jeremy] Boorda [former chief of naval operations who committed suicide last year] challenged us to not only be a system of high quality health care but to also be a system of compassionate and understanding health care," Joseph said. "Adm. Boorda's view of the higher quality physician was not simply a matter of credentials but was rather a measure of compassion and accessibility to the patient."

Ultimately, TRICARE differs from civilian managed care programs, Joseph concluded, in part because of "our unwavering demand for quality. We are different, also because we will not dismantle the health care benefit for our patients. We continue to find better ways to care for their health needs."

While DoD health care faces the same challenges as other agencies to conserve finances, Joseph said, DoD military health care must fully support operational readiness.

"Supporting readiness and providing a quality health benefit are the twin missions of military medicine," Joseph said. "As commanders and staff of our medical treatment facilities, you must ensure the active forces you support are medically ready to accomplish their missions. You must be prepared to deploy yourselves in direct support of those forces, and you must care for the families of those who have deployed."

Technological advances have played an integral role in delivering medical care and must continue to do so, Joseph said. "Harnessing the advantages of new technologies to enhance our ability to provide high quality, effective health care extends to our deployed forces as well as to our patients."

He cited the impact of telemedicine that "enables us to project real time, specialized health care services in the form of diagnoses and consultation forward to the patient." Telemedicine, he said, "facilitates high quality, sophisticated care."

Joseph also lauded an initiative that grew out of DoD's clinical investigation of Gulf War illnesses, a variety of health problems thousands of veterans have said their participation in the war caused. The Medical Deployment Surveillance Program will "enhance medical surveillance and monitor the health and well-being of our men and women in uniform, especially in situations where they're deployed to a potentially hazardous area," Joseph said.

The program involves ongoing systematic collection, analysis and interpretation of health data for use in preventing and controlling illnesses and injuries. "I believe this program will quickly evolve into a major advance in the history of military medicine," Joseph said.

Military medicine traditionally focused on critical but short-term health problems in the field, he said. However, the new surveillance program "will have the capability to recognize and ultimately prevent risk factors contributing to chronic adverse health" that occur after the conflict ends and the troops redeploy.

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