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Do Not Look to Military Health System as Universal Model, Says Report

Cheryl Clark, for HealthLeaders Media, December 3, 2009

The military system of healthcare may be one example of universal coverage for a population, but applied on a broader scale with variations of a so-called public option, it may not match what is now available for civilians. And it won't solve the nation's healthcare access problems.

Those conclusions came in a report from Mathematica Policy Research, a nonprofit research group, which says that based on a look at the military healthcare system, without strengthening primary care and public health initiatives, universal coverage alone won't solve access to care problems in the U.S.

"Even if current healthcare proposals focused on universal coverage, insurance reform, and cost control are successful, some of the most vexing problems in the current system are likely to persist," said Thomas Croghan, MD, the report's lead author and senior researcher at Mathematica. "Policymakers must continue to address important issues, such as racial and ethnic disparities, timely access to needed care, and dissatisfaction with care received."

The Department of Defense covers more than 9.5 million active duty, retiree, and dependent beneficiaries, and at the same time, provides military readiness for a much more acute need for those wounded in war. In addition to military hospitals and clinics, it provides care through 1,700 acute care civilian hospitals, 300,000 civilian physicians, and 60,000 pharmacies around the world.

The Mathematica paper raised three points:

1. The research team performed a cohort study of children enrolled in TRICARE Prime, which is similar to health maintenance organizations for civilians, during 2007 and analyzed claims for all inpatient outpatient and prescription drug services delivered by military or civilian providers. They measured differences in asthma prevalence and treatment, and asthma-related avoidable hospitalizations and non-injury emergency use for Hispanic, non-Hispanic white, and non-Hispanic African American children with asthma ages 2 to 4, 5 to 10 and 11 to 17.

The researchers said that while significant racial and ethnic disparities in child health exist, especially in the treatment of asthma, enrolling in the military's universal comprehensive coverage system "did not eliminate racial and ethnic disparities" for those military dependents children.

2. The Mathematica team conducted 20 focus groups with active duty dependents, retirees, and retiree dependents in four regions served by military treatment facilities to hear in the beneficiaries' own words the attitudes and beliefs about access to and delivery of services by the military health system.

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