Defense Health Care

Congress has questioned whether beneficiaries of the military's health maintenance organization--TRICARE Prime--are able to schedule timely appointments for care. GAO found that 70 percent of appointments for a routine visit at a military treatment facility were scheduled within the Defense Department's (DOD) timeliness standard and that 80 to 97 percent of appointments for acute or preventive care or for specialists were so scheduled. Active duty military and other enrollees may not obtain appointments within DOD's standard because enrollees sometimes request a date later than one offered within the standard, DOD permits nonenrollees to make appointments and obtain care at the facilities, and military beneficiaries traditionally use health care at a higher rate than do private-sector beneficiaries. DOD's current tools for measuring appointment timeliness are inadequate, although it is attempting to improve them. GAO recommends that DOD modify and use its Composite Health Care System instead of its Customer Satisfaction Survey and report the results at all levels. DOD should also test a policy for canceling appointments for nonenrollees when active military or other TRICARE Prime enrollees request care.

GAO noted that: (1) after correcting definitional discrepancies in DOD data, GAO found DOD has not achieved its goal of scheduling 98 percent of acute and routine appointments within the timeliness standards it established; (2) about 70 percent of appointments for a routine visit at military treatment facilities (MTF) were scheduled within the standard, while between 80 and 97 percent of the appointments for acute care, preventive care, or specialists were scheduled within the relevant standards; (3) DOD's analysis of appointment timeliness is consistent with GAO's findings, and DOD has reported that the MTFs' performance has fallen short of its expectations; (4) there are several reasons why active duty members and other enrollees may not obtain appointments within the standards; (5) GAO found that about 16 percent of the appointment slots were given to nonenrolled beneficiaries; (6) DOD permits nonenrollees to make appointments and obtain care in MTFs because it believes treating these beneficiaries is necessary to support medical readiness and training requirements; (7) DOD has made no analysis, however, of the extent to which this policy adversely affects the ability of the enrolled population to obtain care and treatment or the effect of any resulting shortfall on readiness and training; (8) research by the Congressional Budget Office has shown that instituting a copayment for care provided in MTFs could reduce demand for care and improve appointment timeliness by freeing up appointments for active-duty members and Prime enrollees; (9) DOD's data tools are inadequate for measuring appointment timeliness against the access standards; (10) survey weaknesses include reliance on the beneficiaries' ability to correctly recall details of the appointments, a low response rate, and no analysis of the beneficiaries who do not respond--all of which affect the accuracy of the information on how well appointment standards were met; (11) DOD also has several efforts under way to improve the data contained in the Customer Satisfaction Survey and Composite Health Care System (CHCS) appointment scheduling system; and (12) once implemented, CHCS promises to become a good source of the appointment timeliness information DOD needs to effectively manage and monitor access to care.

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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