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Quality Good, Access Not So Good, Health Care Survey

American Forces Press Service

WASHINGTON, Sept. 11, 1996 – Beneficiaries of DoD health care praise the quality of care but say it's still too hard to get an appointment, according to a DoD survey.

The department released results of the survey Sept. 10. Conducted in spring 1995, the survey queried more than 160,000 active duty personnel, retirees, family members and survivors on such issues as access to health care, satisfaction with military and civilian providers, health status and use of health care and preventive services. Participants were selected at random. About 54 percent returned their questionnaires.

"This survey solidly reinforces our determination to pursue TRICARE, DoD's managed health care program designed to improve access to care," said Dr. Stephen C. Joseph, assistant secretary of defense for health affairs. "Access to military health care is our No. 1 problem."

Results showed the majority of beneficiaries (58 percent) rely on military facilities for their care. This figure ranged from 92 percent of active duty personnel to 35 percent of retirees age 65 and over. Overall, three-quarters of military beneficiaries said they made at least one outpatient visit in the previous 12 months, while 12.5 percent said they spent at least one night in the hospital during the same period. Those who used military facilities rated them as 3.4 on a scale of 1 to 5, with 5 being excellent. Beneficiaries expressed higher satisfaction with quality of care than with access to care.

"It is interesting that members of retiree households gave higher ratings than members of active duty households for all aspects of care surveyed," Joseph said. "It may reflect differences in age, and satisfaction generally increases with age. The active duty felt most satisfied with financial aspects of their care, including protection from financial hardship, while retirees under age 65 were most satisfied with the quality of their care."

Queries about access to health care included whether beneficiaries have a regular source of care; travel time to their health care facility; and how many days or weeks they must wait for an appointment. The survey found more than 95 percent have a place where they usually go for health care.

Of the active duty members using a military facility for health care, 88 percent reported travel time under 30 minutes. Among non-active duty beneficiaries the number ranged from 88 percent for active duty family members to 64 percent for retirees over age 65.

Only about 45 percent of active duty personnel and their family members said they waited one week or less for a scheduled appointment. For other types of beneficiaries, only 33 to 38 percent had the same experience.

Both DoD policy makers and local medical facility commanders will use survey results to identify ways to improve the delivery of care to military beneficiaries. DoD will conduct similar surveys annually.

"The data will become more valuable when the department builds up a number of years of experience with the survey," Joseph said. "With several iterations, analysts will be able to examine both the current state of health care and trends for key variables."

Now under way, the 1996 survey includes more questions about TRICARE, which DoD implemented in 1995 not only to improve access but also to maintain high quality and control costs. Health Affairs officials see the survey as an important tool for assessing changes in health care delivery under TRICARE; however, TRICARE will not be fully implemented nationwide until fiscal 1997, they said.

The Defense Manpower Data Center provided technical support and contractual assistance to Health Affairs through all stages of the survey. Representatives from each service participated in developing the survey.

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