Top Doc Urges Care for All, Healthier Lifestyles
By Douglas J. Gillert
American Forces Press Service
WASHINGTON, July 20, 1998 Quality medical care for all beneficiaries and healthier lifestyles that prevent illness and injury top the list of concerns of DoD's new health leader.
Although she said the overriding mission of military medicine is readiness, Dr. Sue Bailey added she's committed to delivering quality care to all beneficiaries.
"We've got a commitment to the quality of the health care that is provided to the 8 million people who depend on us," Bailey said. "Our service members need to be ready and fit to defend the nation, and they need to know that their families at home are taken care of while they're gone. And we have a huge and growing population of retirees who are looking for -- and deserve -- quality health care from us."
Bailey, who became assistant secretary of defense for health affairs in May, said the military health system is at a crossroads that gives leaders a chance to "look at where we've been and where we're going."
"There's been a lot of nostalgia for the way health care used to be," she said. "My dad worked on a B-17 base (in Rapid City, S.D.) during World War II. At the time, the sole purpose of the medical support was to keep those airplanes flying -- keep those pilots healthy. If there were extra medical provisions, family members then could come out to the base to be taken care of."
In the ensuing decades, family members and retirees gained routine access to the same health care as service members. But with downsizing in the 1980s and 1990s came fewer and smaller medical facilities and sharply reduced numbers of health care providers. To continue meeting both peacetime and readiness health care requirements, DoD launched TRICARE in 1992. The managed-care program became fully implemented this summer.
"Today, we are committed to providing top quality health care to all service members, as well as their families and all those who have served and retired from military careers," Bailey said. She gives TRICARE high marks for the choices it offers beneficiaries.
"We have in our system greater choice than most Americans have in their managed care programs," she said. "People who receive health care through their work -- the majority of Americans -- currently have two choices, a preferred- provider option [patients choose physicians from an approved list] or a health maintenance organization. Most other managed-care programs have dropped their fee-for- service option, but TRICARE provides the flexibility of all three."
Although timely access to health care isn't perfect in TRICARE, it's on a par with civilian programs and getting better, Bailey said. "We would like to be answering the phone quicker, making the appointment quicker, having people seen quicker," she said.
One way of improving patients' health care access is to reduce the demands placed on the medical system, the assistant secretary said. Bailey is especially keen on improving the overall health of service members and their families.
She cited two new DoD initiatives, "Put Prevention into Practice" and a patient survey called Health Enrollment Assessment Review, as ways DoD is striving to create a healthier population. Both measures are geared toward identifying and reducing alcohol abuse, smoking and accidental injury, and promoting physical fitness. She said the initiatives combine education and awareness with counseling, behavioral and fitness programs and will be available to all military beneficiaries.
"For too long in medicine, physicians have been perceived as the [people] to turn to in the event of a health care crisis," she said. "In fact, if you can prevent these sicknesses, essentially you are your own cure. I would urge that kind of preventive thinking throughout the system. There are things people can do to prevent themselves from becoming sick."
But physicians, too, need a new outlook, Bailey said. "They need to focus on preventive health -- not just write prescriptions for antibiotics or do therapeutic interventions, but sit down with their patients and discuss the kinds of things they can do to prevent sickness and disease."
Bailey oversees defense health care policy and believes such policy must include input from providers in the field. For that reason, she's spending as much time as possible visiting hospitals and medics throughout the country.
"I am very interested in knowing how the policies that we create and refine here are implemented," she said. "I also need to see and hear what's going on, what the issues are, so it's very important for me to go out and talk to the people who receive the care and the people who provide the care."
For example, a recent trip to Naval Air Station Jacksonville, Fla., gave her reason to hope DoD can improve retiree care.
"I was very impressed that the hospital there doesn't turn away anyone, including retirees over 65," she said. Retirees 65 and older currently fall under Medicare rules and aren't qualified for care under TRICARE. DoD is working to change this rule, but most military hospitals and clinics in the meantime provide only limited, if any, health care to Medicare-eligible patients.
"If they're doing it, it can be done," Bailey said. "Is there something unique about the Jacksonville experience? Is it something we're going to be able to do elsewhere, given the growing numbers of older beneficiaries in DoD who require more services than our younger population? It's an issue that I will focus on." That includes keeping close contact with Jacksonville, she said.
Another of Bailey's early trips found her aboard a Trident submarine. The visit helped crystallize her role as the principal medical adviser to the defense secretary.
"I walked through the tiny compartments of that submarine, and looked at the faces and talked to the sailors, and spoke with the independent duty corpsman responsible for the health of those 150 people," she said. "I realized -- as I always do when I travel to the facilities and see who's out there -- this is what it's all about."