Defense Health Care:

Resources, Patient Access, and Challenges in Europe and the Pacific

HEHS-00-172: Published: Aug 31, 2000. Publicly Released: Aug 31, 2000.

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Pursuant to a congressional request, GAO reviewed the Department of Defenses (DOD) health care system in Europe and the Pacific, focusing on: (1) what DOD health care resources are available in Europe and the Pacific and what is their cost; (2) how does DOD integrate host nation care into its military health care system; (3) how does DOD ensure the quality of such care; (4) whether beneficiaries have adequate access to medical care; and (5) whether beneficiaries encounter obstacles when obtaining healthcare.

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 for Executive Action

  1. Status: Closed - Implemented

    Comments: According to a recent Air Force study, the fleet of dedicated C-9 aircraft used for aeromedical evacuation needed to be replaced. DOD has identified and pursued several alternatives to using the C-9 airframe for transporting overseas patients needing care not available locally. Specifically DOD has (1) increased the space for patients on scheduled cargo plane missions to the U.S., (2) increased the use of opportune aircraft or commercial alternatives, and (3) pursued using the C-21 airframe equipped with medical capability as a full substitute for the C-9 airframe.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to complete the analysis of aeromedical utilization and implement the best long-term approach identified for transporting overseas patients needing care not available locally.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: DOD agreed that the medical screening processes for overseas active duty members and their families should ensure that they do not have medical problems exceeding the capabilities of military treatment facilities and health providers overseas. DOD stated that it is closely monitoring active duty members and their families to ensure that the screenings accurately disclose their medical conditions. DOD further acknowledged that medical screenings for civilian employees are also important to ensure that overseas facilities have the capability to address their medical needs. In a June 2002 notification, DOD discussed its current policy that requires civilian employees who have been notified that they have been selected for a foreign area position to be medically screened, and to meet the physical requirements for the position prior to an employment commitment.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to improve medical screening policies to help ensure that beneficiaries overseas do not have medical problems exceeding the capacity of MTFs or local health care providers.

    Agency Affected: Department of Defense

  3. Status: Closed - Implemented

    Comments: On July 30, 2001, DOD issued to the Surgeons General of the Army, Navy, and Air Force, and to the Director of Health and Safety of the Coast Guard, a letter reemphasizing that overseas Prime enrollees are allowed to obtain civilian care as needed without preauthorization while traveling in the U.S. Also reemphasized was that beneficiaries enrolled in TRICARE Prime have priority access for care ahead of non-enrolled beneficiaries in all military treatment facilities.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to complete the development of policies reinforcing standards to ensure health care access for overseas beneficiaries when they travel outside their TRICARE regions.

    Agency Affected: Department of Defense

  4. Status: Closed - Implemented

    Comments: DOD now has policies in place to expand the use of host nation medical providers for overseas patients, and plans to continue seeking opportunities to do more in this important area given the decade-long reductions in military medical personnel overseas. In addition, DOD has implemented a formal mechanism to give feedback to host nation providers on care quality. DOD introduced the formal feedback process in Europe in February 2001, and in the Pacific in September 2001.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to continue working to expand, where possible, the use of host nation providers and provide feedback to such providers on the quality of care.

    Agency Affected: Department of Defense

 

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