Military health care not good enough, DoD official says

Military medicine boasts some of the best doctors, facilities and care available anywhere, but that's not good enough, DoD's top personnel official told health care managers in Washington on Feb. 4.

"Ten years hence, people will come together and say, 'What a tremendous system we have, but there were growing pains in the process,'" said Rudy de Leon, defense undersecretary for personnel and readiness, at the annual TRICARE conference. The military health system, he said, still has to improve how and when patients receive care, how people learn about their health care options, and how and when bills are paid. And, de Leon insisted, DoD has to fulfill its commitment to care for retirees age 65 and older.

Health care is important to service members' quality of life and is one of their greatest concerns, de Leon told the worldwide gathering of military and contract medics. "Our challenge in 1999 is going to be to take important steps forward that will restore people's confidence in their health care," he said.

TRICARE, DoD's managed health care plan, is up and running nationwide. Now, de Leon said, it must ensure beneficiaries receive easily accessible and hassle-free care. "As I talk with our beneficiaries at home and on deployment, a common theme emerges," he said. "Active duty members and their families are pleased with the quality of health care they receive. The problems exist in the level of service."

To learn more about patients' problems with TRICARE, de Leon has conducted town hall-style meetings across the country. He said most of the comments he hears fall into two categories: how long it takes to get through on the telephone to make an appointment, and the times patients have had to deal with their whole bill because the doctor hasn't been paid. Health care providers also focus on the claims process, he said.

Unpaid medical claims are a particular concern, de Leon said. TRICARE-contracted civilian doctors expect their patients to pay when the government is late. "To be successful, we must be credible in the promises that we make to both beneficiaries and providers," he said. "Together, we must resolve that the system will not allow young military families to be hounded by bill collectors or surprised by out- of-pocket costs. And we must do all we can to pay our health care providers on time so that the best civilian doctors and other health care professionals will want to participate in the TRICARE system.

"We have first-class people in our system, we have first-class facilities. One thing we can all pledge for 1999 is that we will have a first-class claims process."

Improving the appointment system is critical, de Leon said, so "beneficiaries do not have to spend their time on the telephone making appointments or wait several weeks to get an appointment."

De Leon said people need to know as much about TRICARE as possible. "We have to do more work on educating our beneficiaries on how TRICARE works," TRICARE has improved military health care, he said, but it doesn't do any good if nobody knows about it or how to use it, he said. He urged medical facility commanders to tell their line leadership, senior noncommissioned officers and patients what they're doing locally to improve health care delivery.

"Engage your community," he said. "These are your neighbors and our people that you're working for.

"We've got to keep the message simple, ensuring service members and their families that TRICARE is there for them in times of need."

That message must extend as well to Medicare-eligible retirees and family members 65 and older, de Leon said. The challenge of finding space and funds to cover the cost of elder care "is going to be with us well into the next century," he said. "We've got to work to make sure we keep faith with our military retirees."

In five years, retirees 65 and older will outnumber active duty beneficiaries in the military health system, de Leon said. He said he's encouraged that Congress will support Medicare Subvention, a Medicare reimbursement program currently being tested at selected military hospitals. He said several senators have told him they support a more inclusive system, allowing retirees to use their Medicare dollars in military treatment facilities.

"We still have a long way to go to meet the commitment for health care that all of our people expect," de Leon said. "But I look out at this audience, and I see the caliber, professionalism and the dedication that exists. You provide very precious benefits both in times of war and peace-gifts of healing and caring. Thank you and I salute you for all that you do."