How Our Armed Forces Can Have Cost-effective and Efficient Medical Care

Nadeen Wincapaw is a military spouse and volunteer contributor:  “Active duty and their families have two basic options for medical care: a “Standard” option and a “Prime” option.  The standards functions much like a traditional insurance plan with co-payments and other out-of-pocket fees for the freedom to choose any doctor, facility, or specialist a family prefers. Prime operates like an HMO with a primary care provider (usually at a military treatment facility) who manages all the care for the patient and makes referrals as needed to specialists in a specified network (explained here). Under either of the plans, there is no monthly premium for active duty service members.

Once the military member has left active duty, either by finishing his/her contract, resigning his/her commission or by retiring (completing at least 20 years of active service), the service member can elect to receive medical care through the Veteran’s Administration, often with little or no out-of-pocket expense.

Sounds straightforward, right?

Well, it’s not.  No two bases’ medical groups are administered the same way; record keeping is different depending on location; quality of care depends on the branch of service; on and on it goes.  Even continued integration of services and joint assignments have failed to standardize medical care.  The quality of care for active duty and their families is not equal.

In the case of a retiree, the Veteran’s Administration duplicates the effort of the TriCare insurance program by providing a second source for treatment. But the VA has been plagued with reports of substandard care, dilapidated facilities, backlogged paperwork and, recently, secret waiting lists. Despite the plethora of issues, the VA annually treats millions of veterans at their 1,700 medical centers across the United States with a budget of over $50 billion.

The budget for the Department of Defense’s medical care was over $52 billion in 2012, and each year that number continues to rise.

It’s time for some real-world ideas on how to cut costs and fix the budget.  The best place to begin is in the duplication of services; medical care is one place where a consolidation of those services can be applied to save money, time, and effort.

All defense-related medical care could be folded into one joint medical command. This would include the Veteran’s Health Administration as well as the TriCare-affiliated care. One large joint command would have the benefit of allowing the standardization of administration, record keeping and personnel management.

Research and development would also be streamlined. Having access to any of the VA and military facilities would open the door for staff to expand their milieu and specialize in a field for advancement (a complaint I have heard from more than one DOD doctor). Allowing the current contractors of TriCare to take over the administration of the combined care would offer less bureaucratic red tape and a more business-oriented direction for the VA.

A modest savings of even 5 percent over the current budgets of the DOD and VA would equal $5 billion dollars.”

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