Defense Health Care: Across-the-Board Physician Rate Increase Would be Costly andUnnecessary

摘要

The Department of Defense (DOD) offers health care to its 8.3 million active dutypersonnel, retirees, and their dependents through its managed health care program called TRICARE. About 75 percent of this care is provided through DOD medical centers, hospitals, and clinics. Civilian physicians, hospitals, and clinics provide the remaining care. Civilian physician care is provided through DOD contracted regional networks or from nonnetwork physicians who are willing to accept TRICAREs reimbursement rates. Military beneficiaries in some locations, such as rural Alaska, are having difficulty obtaining care from civilian physicians, especially certain types of specialty care, and some specialists are seeking reimbursements higher than what TRICARE allows. In areas where access is impaired, DOD can increase TRICARE rates to encourage physicians to treat military beneficiaries. It has done this in rural Alaska because it determined the problem was most severe there. This report describes (1) the potential cost increase if TRICAREs reimbursement rates were set nationally at the 70th percentile of physician-billed charges rather than the current rate and (2) whether DODs use of existing authorities to increase rates has improved physicians willingness to accept TRICARE beneficiaries in Alaska.