Savings to CHAMPUS From Requirement To Use Uniformed Services Hospitals

HRD-79-24: Published: Dec 29, 1978. Publicly Released: Dec 29, 1978.

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If a military dependent needs nonemergency hospital care and lives within a 40-mile radius of a military hospital, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) requires that when available, the patient use the military rather than public hospital facilities in order for the expenses to be covered by the government. This cost savings measure is in jeapordy, however, if the trend toward a decrease in the number of military medical personnel continues. Exceptions to the rule have been made in cases when the travel distance exceeds the 40-mile limit, the traveling would prove to be a hardship to the patient, or when the needed medical facilities are not available at a military installation.

If the Department of Defense (DOD) assessment of the military's future physician staffing problems is accurate, GAO feels that even with better program management, possibilities for increased savings from the CHAMPUS program are limited. In many instances, individuals do not make use of the military facilities because of a lack of knowledge of the program requirements or because of loopholes in the regulations. An example is the nonavailability statement required before a patient uses a private facility because adequate care is not available at the nearby military hospital. This is often signed after the patient has been to the outside physician and, in some cases, without checking on the availability of care by the military. Regulations also allow a patient who has been under the care of a private physician to continue, even if a military hospital is nearby. This concept has been used by patients to circumvent the CHAMPUS regulations.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of Defense should address the need for high level DOD approval of establishing set procedures for exemptions to the 40-mile regulation of CHAMPUS. Guidelines defining the program should be clearly established and the information relayed to military personnel and their dependents. Since nonavailability of service at military hospitals is the most common reason for patients using private facilities, coordination between hospitals of available care is needed on a case-by-case basis to ensure that a patient will not needlessly use outside sources when adequate military care is available within the 40-mile CHAMPUS limit.

    Agency Affected:

 

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