Defense Health Care

To provide health care to beneficiaries in Europe and the Pacific in fiscal year 1999, the Department of Defense (DOD) spent about $463 million on hospital and clinic operations, maintenance, and inter-facility transport and about $609 million to compensate military personnel who work at military treatment facilities (MTFs). MTFs in Europe have established formal host provider networks that serve TRICARE beneficiaries. TRICARE Pacific relies on State Department resources and a contractor to arrange health care for many remote beneficiaries. DOD generally relies on local certification and licensing practices to determine network physician and facility qualifications. To ensure quality of care, DOD and the State Department rely on local standards and patient feedback. Beneficiaries have better access to medical care with the implementation of TRICARE overseas and the increased use of host nations to augment MTF care. Most scheduled appointments meet the TRICARE access standards governing waiting times. MTF specialty care appointments are not always available; referrals are then made to local providers. DOD's overseas medical system faces many challenges as DOD seeks to maintain access to care for beneficiaries, replace the aeromedical evacuation system, and identify family members of active duty personnel with significant health problems.

GAO noted that: (1) DOD maintains in Europe and the Pacific an extensive system of 18 hospitals and 69 clinics providing primary and specialty care to about 500,000 beneficiaries in over 100 countries; (2) DOD spends about $1.1 billion annually to staff, operate, and maintain these overseas military treatment facilities (MTF); (3) most beneficiaries live near MTFs and receive their care from military physicians, although host nation providers and facilities are also used to augment MTF resources; (4) in Europe, MTFs have developed formal networks of English-speaking host nation providers to serve as referral specialists; (5) in the Pacific, MTFs have traditionally used less local care and have not developed formal provider networks; (6) Pacific MTFs, more so than those in Europe, rely on transporting patients between MTFs for specialty care; (7) beneficiaries living in remote areas hundreds of miles from MTFs particularly in the Pacific, provide DOD a major care challenge; (8) for such beneficiaries, DOD relies on various care sources, including Department of State health clinics and local health care, as well as on transporting patients to distant MTFs; (9) to improve services in the Pacific remote areas, DOD recently hired a contractor to arrange for and manage the care of beneficiaries living there; (10) DOD and the remote beneficiaries have given high ratings to this contractor's services; (11) to ensure host nation provider quality, DOD relies primarily on each country's licensing and credentialing requirements, as well as on limited inspections and monitoring by U.S. military physicians; (12) differences in language, culture, and health care practices between the U.S. and the Europe and Pacific Regions at times can cause frustrations and inconveniences for beneficiaries using host nation care; (13) using MTF and local providers, DOD has generally been able to ensure timely access to both primary and specialty care, however, specialty care is not always available within the 4-week TRICARE access standard, and local specialty providers are not available in all areas; (14) the medical systems in Europe and the Pacific face continuing challenges; (15) DOD believes that aircraft serving the aeromedical evacuation system may need to be replaced soon; (16) DOD is now seeking to expand local care options in some overseas locations and has begun reviewing alternatives for its aeromedical evacuation needs; and (17) DOD officials plan to review concerns about overseas screening and benefit portability.

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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