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The U.S. Department of Defense (DoD) has increasingly confronted financial, managerial, and operational challenges in sustaining health benefits for service members and their families: For example, medical costs are projected to increase to 12 percent of DoD's total budget in 2015, from a level of 8 percent in 2007. To address these challenges, DoD is working to transform business practices within the Military Health System. As part of this effort, DoD has considered setting targets for health care utilization in its military treatment facilities (MTFs) and rewarding or penalizing MTFs according to their performance. In this volume, the authors discuss the potential and limitations of using MTF utilization and costs as measures of MTF leaders' performance. Nicosia, Wynn, and Romley report the findings of (1) their qualitative review of performance assessment in the nonmilitary health care sector and (2) their quantitative analysis of how MTF utilization and cost metrics are limited by random variation in the data, and how MTF size and resource-intensive catastrophic cases affect this variation.
Table of Contents
Chapter One
Introduction
Chapter Two
The Context for Assessing the Performance of Military Treatment Facilities
Chapter Three
Performance Assessment in Health Care
Chapter Four
Performance Assessment and MTF Size
Chapter Five
Performance Assessment and Catastrophic Cases
Chapter Six
Conclusions
Appendix A
Some Statistical Issues in Performance Assessment
Appendix B
Detailed Results of Benchmark Analysis of MTF Outcomes
Appendix C
Outpatient Utilization and MTF Size
Appendix D
Catastrophic Hospital Admissions
Appendix E
Detailed Results of Analysis of Catastrophic Hospital Admissions
Research conducted by
The research described in this report was sponsored by the Assistant Secretary of Defense for Health Affairs and conducted by the RAND Center for Military Health Policy Research, a joint project of RAND Health, and the Forces and Resources Policy Center of the RAND National Defense Research Institute. The latter is a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Department of the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.
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