TRICARE: transformation of the military health care system : demystifying military medicine and the mission impossible

Abstract

The Department of Defense's military health care system, entitled TRICARE, brings together the direct health care resources of the Department of Defense and supplements this capability through the use of managed care support services contracts and purchased care. This blended system is charged with providing a comprehensive health benefit to approximately 8.9 million beneficiaries, including active duty and retired uniformed services members, their families, and survivors, while also providing medical support to military operations. The defense health program differs in so many ways from other employer-sponsored health plans that the label itself seems inappropriate at times, as this discretionary budget program resembles more of an entitlement than a benefit. In the late 1980's and early 1990's, faced with escalating health care costs, a transition to managed care seemed like an understandable and natural response to what was then a national belief that market forces could improve health care quality and lower costs. The concept of managed competition proliferated as managed care took hold in the United States and became the cornerstone of many private and public health plans, including the Federal Employee Health Benefit Plan (FEHBP). FEHBP has received bipartisan recognition as one of the government's more successful undertakings and a model for federal health insurance purchasing, as health care reform proposals frequently focus on expanding the FEHBP. Comparable in size to TRICARE, the FEHBP currently covers nine million active and retired federal employees and their dependents, and is the nation's largest employer-sponsored health insurance plan. Not surprisingly, some have argued the logical result would have been for the military to adopt the FEHBP as their purchased care model.