Military Health Care

GAO analyzed data for appointment scheduling in the four TRICARE regions in November 1999 and found that only about one-quarter of the TRICARE contractors have appointment-making responsibility. In general, these contractors scheduled a higher percentage of appointments for clinics that provide primary care services than for those that provide specialty care. In the four regions, DOD and its military treatment facilities (MTFs) have restricted the types and numbers of appointments available to the contractors for scheduling because some professional staff do not trust contractors to accurately schedule appointments and to ensure that any medical instructions--like fasting--be provided before the visit. When comparing like clinics within different MTFs, the percentage of appointments scheduled by contractors varies substantially. When there are DOD and MTF restrictions, beneficiaries requesting appointments from the contractor may be transferred to the MTF clinic or told to call the MTF directly. Although DOD is reducing and standardizing the number of appointment types and names used throughout the military care health system, DOD has not yet decided on or implemented a more uniform process for making appointments.

GAO noted that: (1) contractors scheduled only about one quarter of the appointments during November 1999 in the four regions where TRICARE contractors have appointment-making responsibility; (2) the percentage of appointments scheduled by the contractors varied among the regions, ranging from about 17 percent to about 63 percent; (3) in general, contractors scheduled a higher percentage of appointments for clinics that provide primary care services (42 percent) than for clinics providing specialty care, such as dermatology, cardiology, and orthopedics (17 percent); (4) in the four regions, the Department of Defense (DOD) and its military treatment facilities (MTF) have restricted the types and number of appointments available to the contractors for scheduling; (5) some MTF physicians and other professional staff told GAO that they want to retain control over the appointing process because they do not trust contractors to accurately schedule appointments and to ensure that any medical instructions can be provided prior to the visit, such as instructions about fasting; (6) when comparing like clinics within different MTFs the percentage of appointments scheduled by contractors varies substantially, suggesting that physicians' and other staff's desire to retain appointment control may be the driving factor, rather than the need to provide medical instructions; (7) when contractors do not have access to appointments because of DOD and MTF restrictions, beneficiaries requesting appointments from contractors may be transferred from the appointment center to the MTF clinic, or told to call MTF clinics themselves; (8) thus, what was meant to be a simplified, more user-friendly appointment process is now a complex and confusing process in which beneficiaries are unsure whether to call the contractor or the MTF to schedule appointments; (9) to improve its appointment system, DOD is in the process of reducing and standardizing the number of appointment types and names used throughout the military health care system; (10) currently thousands of appointment types and names are used; and (11) although reduction and standardization could simplify the appointment-making process, until DOD decides on and implements a more uniform process for making appointments, there will continue to be differences in how beneficiaries access the military health care system.

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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