Defense Health Care

Eight million people are eligible to receive health care through the military's $15-billion-per-year health system. In 1993, the Defense Department (DOD) made a major change to its health care system: conversion to a managed care program known as TRICARE. Just as in the private sector, where customer feedback is a key management tool, an important measure of TRICARE's success is whether beneficiaries are satisfied. This report discusses (1) whether DOD solicits beneficiaries' feedback and, if so, how this is done (such as through surveys) and what the data show; (2) what other means are available to beneficiaries to provide feedback and what such beneficiary-initiated feedback could reveal about TRICARE's success; and (3) how DOD's approaches to obtaining feedback compare with the private sector's and whether opportunities exist to improve DOD's beneficiary feedback tracking and reporting.

GAO noted that: (1) DOD obtains and uses TRICARE beneficiary feedback in several ways across the military health system (MHS); (2) DOD conducts a broad annual beneficiary questionnaire survey and a monthly survey of patients' perceptions of military treatment facilities (MTF) outpatient visits--both of which are based on private-sector models--to measure levels of satisfaction with TRICARE; (3) DOD reports the survey results throughout the MHS; (4) DOD does not conduct such surveys of MTF inpatient users or civilian network care users, though DOD officials told GAO that they are now planning to develop an MTF inpatient survey; (5) as TRICARE continues to be phased in across the MHS, DOD's annual surveys are indicating fairly levels of overall beneficiary satisfaction with the program, but lower satisfaction levels with aspects of military care; (6) DOD also tracks and reports beneficiary-initiated feedback--complaints and other comments--in ways that vary throughout the MHS; (7) a wide range exists in how much feedback information is tracked and in how the different levels of units that compose TRICARE--and other DOD offices--do the tracking; (8) beneficiary-initiated feedback reporting throughout the MHS varies as well; (9) because of the variability of DOD's recording of these data, reliably depicting the range, magnitude, or frequency of beneficiary feedback about TRICARE is not possible; (10) private health care managers rely extensively on beneficiary feedback; (11) surveys, which provide data about whole customer populations, and customer-initiated complaints, which show where specific problems have occurred, are used together as key tools to measure plan performance and identify systemic problems; (12) while no direct private-sector parallel to MHS exists, DOD's feedback efforts are somewhat similar to the private sector's, although adopting certain private practices might improve DOD's feedback systems; (13) more reliable beneficiary feedback data would also help DOD to make customer satisfaction an outcome measure in the next round of TRICARE contracts, which DOD is trying to base more on outcomes and less on process; and (14) to improve its beneficiary feedback approaches, DOD will need to consider a number of cost-benefit issues, the varying sophistication levels of beneficiary feedback management throughout MHS, and other matters.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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