Defense Health Care:

DOD Could Improve Its Beneficiary Feedback Approaches

HEHS-98-51: Published: Feb 6, 1998. Publicly Released: Feb 6, 1998.

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Stephen P. Backhus
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Pursuant to a congressional request, GAO reviewed: (1) whether the Department of Defense (DOD) solicits feedback from beneficiaries of its managed health care program, TRICARE, and, if so, how this is done and what the data show; (2) what other means are available to beneficiaries to provide feedback and what such beneficiary-initiated feedback could reveal about TRICARE's success; and (3) how DOD's approaches to obtaining feedback compare with the private sector's and whether opportunities exist to improve DOD's beneficiary feedback tracking and reporting.

GAO noted that: (1) DOD obtains and uses TRICARE beneficiary feedback in several ways across the military health system (MHS); (2) DOD conducts a broad annual beneficiary questionnaire survey and a monthly survey of patients' perceptions of military treatment facilities (MTF) outpatient visits--both of which are based on private-sector models--to measure levels of satisfaction with TRICARE; (3) DOD reports the survey results throughout the MHS; (4) DOD does not conduct such surveys of MTF inpatient users or civilian network care users, though DOD officials told GAO that they are now planning to develop an MTF inpatient survey; (5) as TRICARE continues to be phased in across the MHS, DOD's annual surveys are indicating fairly levels of overall beneficiary satisfaction with the program, but lower satisfaction levels with aspects of military care; (6) DOD also tracks and reports beneficiary-initiated feedback--complaints and other comments--in ways that vary throughout the MHS; (7) a wide range exists in how much feedback information is tracked and in how the different levels of units that compose TRICARE--and other DOD offices--do the tracking; (8) beneficiary-initiated feedback reporting throughout the MHS varies as well; (9) because of the variability of DOD's recording of these data, reliably depicting the range, magnitude, or frequency of beneficiary feedback about TRICARE is not possible; (10) private health care managers rely extensively on beneficiary feedback; (11) surveys, which provide data about whole customer populations, and customer-initiated complaints, which show where specific problems have occurred, are used together as key tools to measure plan performance and identify systemic problems; (12) while no direct private-sector parallel to MHS exists, DOD's feedback efforts are somewhat similar to the private sector's, although adopting certain private practices might improve DOD's feedback systems; (13) more reliable beneficiary feedback data would also help DOD to make customer satisfaction an outcome measure in the next round of TRICARE contracts, which DOD is trying to base more on outcomes and less on process; and (14) to improve its beneficiary feedback approaches, DOD will need to consider a number of cost-benefit issues, the varying sophistication levels of beneficiary feedback management throughout MHS, and other matters.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: DOD has awarded contracts to conduct two beneficiary satisfaction surveys: (1) a survey of beneficiaries receiving civilian network care--data collection will start in November 2000 and results are expected in February 2001; and (2) a survey of beneficiaries receiving MTF inpatient care--data collection is currently underway and results are expected in October 2000.

    Recommendation: To position DOD to obtain and make better use of beneficiary feedback, both now and in the future, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to follow through in weighing the costs and benefits associated with civilian network and MTF inpatient care surveys that are comparable to DOD's current monthly MTF outpatient survey and, as appropriate, implement these surveys.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: In January 2000, DOD established Beneficiary Counseling and Assistance Coordinators--a full-time Lead Agent office position and a collateral MTF duty--to work with the TRICARE contractors in resolving beneficiary complaints. In a related action, in July 2000 DOD created a Debt Collection Assistance Officer Program, dedicating Lead Agent office staff and MTF staff to helping beneficiaries with debt collection problems. That same month, a contract modification required TRICARE contractors to report to DOD regarding beneficiaries' debt collection issues. In August 2000, DOD developed a database for tracking complaints into TRICARE headquarters.

    Recommendation: To position DOD to obtain and make better use of beneficiary feedback, both now and in the future, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to collaborate with the TRICARE contractors to identify options for, and weight the costs and benefits of, achieving consistency in recording beneficiary complaints, analyzing trends, and reporting beneficiary complaints and, as appropriate, implement the most practical, financially prudent approach.

    Agency Affected: Department of Defense


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