TRICARE-covered children face challenges accessing health care, with the greatest challenges among children who have experienced frequent relocations and children with special health care needs. Analyses of survey data allow a comparison between children with TRICARE and other types of insurance, as well as between children who have changed addresses more and less frequently and between children with special health care needs and those without.
Download
Download eBook for Free
| Format | File Size | Notes |
|---|---|---|
| PDF file | 0.8 MB | Use Adobe Acrobat Reader version 10 or higher for the best experience. |
Purchase
Purchase Print Copy
| Format | List Price | Price | |
|---|---|---|---|
| Add to Cart | Paperback114 pages | $22.00 | $17.60 20% Web Discount |
Research Questions
- How does access to pediatric health care differ for children with TRICARE coverage and children with other types of insurance?
- 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?
- To what extent do military service relocations affect TRICARE-covered children's access to health care?
- 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
Research conducted by
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).
This report is part of the RAND Corporation Research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.
This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.