The Demand for Military Health Care
Supporting Research for a Comprehensive Study of the Military Health Care System
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For a number of reasons, military beneficiaries — active-duty service members, military retirees, and their dependents — are heavier users of medical care than are comparable civilian populations. These services are currently provided by military treatment facilities (MTFs) or the civilian medical facilities, the latter through the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). However, over the past several years, the system has faced the twin challenges of downsizing in consonance with the rest of the Department of Defense and of controlling escalating health care costs. While care provided in the civilian sector can be more expensive than that provided in the MTFs, the free care available in MTFs sparks greater demand. Moreover, the MTF system was designed to meet wartime, rather than peacetime needs. In weighing the pros and cons of various alternatives, this report suggests that beneficiaries might prefer civilian health plans, as long as there is no erosion of benefits in making such a shift.
Table of Contents
Chapter One
Introduction
Chapter Two
Structure of the Current Military Health Services System
Chapter Three
Health Care Utilization in the MHSS
Chapter Four
Analytic Cases Developed to Study Demand in the MHSS
Chapter Five
The Effects of Changes in the MHSS on Health Care Demand
Chapter Six
Utilization and Costs in Cases with Commercial Health Plans
Chapter Seven
Conclusions
Appendix A
Survey Weights
Appendix B
Military/Civilian Utilization Comparisons: Data and Methods
Appendix C
Regression Methods for Predicting Demand in Alternative Systems
Appendix D
Adjustments to MTF Utilization Estimates for Costing by IDA
Appendix E
Analyses to Predict MTF Utilization and Civilian Costs for Cases 3 and 4
Research conducted by
The research described in this report was sponsored by the Office of the Secretary of Defense under RAND's National Defense Research Institute, a federally funded research and development center supported by the Office of the Secretary of Defense, the Joint Staff, and the defense agencies.
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