Defense Health Care: Appointment Timeliness Goals Not Met; Measurement Tools Need Improvement

HEHS-99-168 Published: Sep 30, 1999. Publicly Released: Sep 30, 1999.
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Pursuant to a congressional request, GAO reviewed the Department of Defense's (DOD) administration of its health maintenance organization, TRICARE Prime, focusing on: (1) DOD's performance in scheduling appointments; and (2) possible reasons why Prime enrollees might not obtain appointments within the appointment timeliness goals.

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Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense The Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to measure and monitor beneficiaries' access to health care in a more comprehensive and accurate manner by directing that CHCS be used in lieu of the Customer Satisfaction Survey to measure compliance with the appointment timeliness standards in the military medical facilities, and that the necessary modifications be made to CHCS so that appointments are linked to the appropriate access standard and standardized across the military health care system. The Secretary should direct that the results be reported at all levels--individual facility, service- and system-wide, and by the various beneficiary categories.
Closed – Implemented
According to our point of contact, CHCS is now being used to measure compliance with appointment timeliness standards. Appointments are also being linked to the appropriate access standard across the system. CHCS was modified to perform this function, alpha testing was completed in April 2000, and worldwide implementation occurred in June 2000.
Department of Defense The Secretary of Defense should direct a test of a policy that appointments scheduled for nonenrolled beneficiaries are subject to cancellation if an active-duty member or other Prime enrollee requests care and no other appointment is available within the access standard. This test could be implemented in those MTFs having the greatest difficulty scheduling active-duty and enrollees within the access standards.
Closed – Not Implemented
DOD has emphatically stated that appointments for non-enrolled beneficiaries will not be canceled and rebooked if Prime enrollees and active duty members request appointments and none are available. While DOD recognizes that active duty should always have first access to medical care, DOD is concerned that adopting this action could jeopardize the health of non-enrolled beneficiaries.
Department of Defense The Secretary of Defense should test the option of instituting copayments within the MTFs comparable to those in the civilian networks to help bring about more appropriate utilization of military care and thus free up appointment space.
Closed – Not Implemented
DOD stated it will not impose copayments for care provided in military medical facilities. DOD considers providing care no-cost care a key component of their commitment to beneficiaries.

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