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Research Questions

  1. How does access to pediatric health care differ for children with TRICARE coverage and children with other types of insurance?
  2. To what extent are TRICARE-covered children with special health care needs able to get the services they need, including referrals and care coordination support?
  3. To what extent do military service relocations affect TRICARE-covered children's access to health care?
  4. Are there differences in access to care for children across TRICARE, including type of plan and active-duty versus non–active-duty?

TRICARE, the U.S. Department of Defense insurance program for eligible service members and their dependents, provides health care coverage to nearly 2 million children under the age of 18. Survey data and prior evaluations indicate that TRICARE-covered children face challenges in accessing pediatric health care, with the greatest challenges among children who have experienced frequent relocations and children with special health care needs. However, TRICARE has not measured pediatric patient experiences in accessing care since 2010. To fill this gap, RAND researchers analyzed national survey data on the experiences of caregivers of TRICARE-covered children and children with commercial insurance, public insurance, and no insurance to identify differences in access to pediatric care, necessary referrals, care coordination support, ability to pay medical bills, and other factors. Additional analyses highlight variations between children with different TRICARE plans, between children who have changed addresses more and less frequently, and between children with special health care needs and those without. The findings should help inform efforts to increase access to care for children across the Military Health System, as well as improvements to programs designed to support military families during relocations and those with children who have special health care needs.

Key Findings

TRICARE-covered children have similar access to health care as children with other types of insurance, but there are some differences

  • Caregivers of TRICARE-covered children were more likely to report having coverage for mental and behavioral health needs and less likely to report problems paying for health care.
  • They were less likely to have one person they considered their child's personal provider, were more likely to need referrals, and reported greater difficulty getting referrals.
  • Among TRICARE beneficiaries, active-duty families were more likely to have a usual source of care and less likely to have problems paying for care. Access to care also varied slightly across different TRICARE plans.

TRICARE-covered children with complex health needs may face particular challenges getting care and services

  • Among TRICARE beneficiaries, caregivers of children with special health care needs reported more difficulty getting referrals for specialty care, were more likely to report not getting needed care, had more frustration getting care, and had a greater desire for care coordination help than caregivers of children without special health care needs.

Relocations can be burdensome for military families and can affect children's access to health care

  • TRICARE-covered children experience more address changes in their lives than children with other types of insurance.
  • Disruptions caused by military relocations may be particularly detrimental for children with special health care needs.
  • Within TRICARE, children who moved frequently reported significantly worse access than those who had never moved over a child's life, including more desire for increased care coordination.

Recommendations

  • Routinely collect data from TRICARE beneficiaries on pediatric patient experiences. Currently, external data are the only means of comprehensively tracking the health care experiences of TRICARE-covered children and comparing them with those of children with other types of insurance.
  • Further streamline referrals for TRICARE beneficiaries and monitor the effects on their experiences accessing pediatric health care and services. Collect and monitor data on the impact of efforts to improve the referral process that are already underway.
  • Fully implement U.S. Department of Defense plans to monitor the effects of permanent changes of station and other relocations related to military service. Relocations can exacerbate access challenges for military children; better data would help evaluate programs to mitigate these effects. Additionally, explore whether transitional assistance during relocations should be made available to a wider set of families than those that are currently eligible.
  • Review the availability and use of care coordination services for TRICARE-covered children with complex health care needs, who face particular challenges getting necessary care and referrals.
  • Further investigate variations in pediatric access by service branch and geography.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Study Objective and Overview of Methods

  • Chapter Three

    Evaluation of Access to Care Among TRICARE-Covered Children

  • Chapter Four

    Children with Special Health Care Needs

  • Chapter Five

    Impact of Relocations on Access to Care for TRICARE-Covered Children

  • Chapter Six

    Summary and Recommendations

  • Appendix

    Detailed Analytic Results

This research was sponsored by the Defense Health Agency and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).

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