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Budgetary Concerns Challenge Medical Leadership

By Douglas J. Gillert
American Forces Press Service

ARLINGTON, Va., Aug. 2, 1997 – Reduced budgets for fiscal 1998 and beyond present a formidable, but not insurmountable, challenge, Dr. Ed Martin told participants at the 1997 summer TRICARE conference here July 29-31.

"We have $100 million more than last year [in the defense appropriation]," the acting assistant secretary of defense for health affairs told commanders and key staff members of the military health services system. "With no changes or correcting for inflation, we would have gotten $250-300 million [in additional appropriations]. The difference helps us define the magnitude of activities we have to carry out this year."

Despite insufficient funding, Martin said, the military health services system must "live within the appropriation so as not to compromise patient care." He cited past achievements as reason to believe in future success. "We should be emboldened by our substantial accomplishments," he said.

Martin said medical treatment facility commanders face the challenge of ensuring active duty service members and their families enroll in TRICARE, while nurturing DoD's moral obligation to military retirees.

For several years, DoD has tried unsuccessfully to get Congress to authorize a demonstration of Medicare subvention. This is an agreement between DoD and the Department of Health and Human Services to reimburse military facilities for care they provide to military retirees older than 65 and eligible for Medicare. This year is no different, but Martin said he's optimistic a demonstration will take place.

The proposed fiscal 1998 DoD budget allocates $1.4 billion, the amount officials estimate it will cost to take care of Medicare-eligible patients during a subvention demonstration. Those funds are in the resolution bill now awaiting passage, Martin said.

The overall conference objective was to prepare medical service leaders to be agents of change.

"This conference is designed to assist you in becoming conversant on the recent changes of our system, and the policies which implement theses changes," Martin wrote in the forward to the conference brochure. "I urge you to ... return to your organizations with new insights and ideas that will enable you to continue to move our health care system further in the direction of worldwide excellence."

Martin also delivered the keynote address to the approximately 300 health care professionals from bases and facilities worldwide. "Most of the important things we've done over the last three to five years have been the easy things," Martin told them. "The next three to four years will be more difficult."

During the conference, participants analyzed and discussed a wide range of issues related to military health care, including:

  • Pressures related to ongoing legislative, budgetary and Quadrennial Defense Review processes;
  • Successful TRICARE deployment, including pharmacy operations, information systems and proper use of report cards, metrics and surveys to assess progress and customer satisfaction;
  • Effective collaboration among leaders of TRICARE, service headquarters, intermediate headquarters, hospitals and clinics; and
  • The fundamentals of enrollment-based capitation, a system of determining facility budgets based on potential TRICARE enrollments, slated to begin Oct. 1.
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