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Military health care should provide:
► Respect for, and genuine concern for both the health care and the personal needs of patients.
► An opportunity for patients to freely choose reasonable, appropriate, quality, and affordable care without unreasonably punitive personal financial liability.
► Clear statements about, and knowledge of, the health benefit package and coverage.
► An understanding of personal choices that may be available.
► Confidence in the competence of the health care provider and managing system.
► To the extent that health care
is not free, or requires only nominal payment, that clear details be provided about likely out-of-pocket cost, and that this be done in advance.
► A clear understanding of the patient’s responsibility to pay for noncovered, nonavailable services.
► Consistent and known providers and facilities for care, both routine and emergency.
► Assurance that the health care setting is appropriate to the conditions, problems, or illnesses.
► Assurance that health care will intrude only to the extent of clear need.
► Responsiveness to and availability of appointments.
► Continuity of care.
► Effective assistance in accessing noncovered services, including referral assistance to government and nongovernment sources-
► Assurance of a minimum of paperwork, submission of insurance forms, and prompt reimbursements.
Rear Admiral Stephen Barcheh Medical Corps. U. S. Na')
(Retired)
Editor’s Note: The above is excerpt from a private letter tho1 Admiral Barchet sent to Dr' Smith that is reprinted with both parties’ permission■
The CHAMPUS Prime program hopes to address several critical issues: lack of access, quality of benefits, affordability of services, ease of administrative procedures, and coordination between the health care network’s military and civilian sectors.
The enrollees would receive any civilian care required from a preferred provider network, if care at MTFs is not available. DoD expects CHAMPUS Prime to cost the government less than existing CHAMPUS, because contractors can secure discounts from civilian physicians and hospitals in exchange for directing patients to them. It would be financially advantageous to the contractor if as much care as possible were rendered at the MTFs. Accordingly, the arrangement encourages the contractor and the MTF staff to share staff—including physicians and support staff. By supplying qualified civilian personnel to fill in the gaps at the MTFs, the contractors will keep the MTFs functioning in the face of periodic staff shortages. The civilian contractor’s incentive will be to assist MTF commanders in providing military medical care rather than paying for more expensive civilian care.
Unfortunately, increasingly constrained budgetary outlays allocated to defense have now become a bone of contention between the perceived entitlements of beneficiaries and the demands of the military establishment with increasingly expensive equipment and personnel. The expanding population of eligible beneficiaries, as well as increased use rates and increased lengths of hospital stays, have placed heavy demands upon health-care providers. Increasingly, expensive technology has led to advances in medical science. The perceived “right” of all our citizens to the “best” that our society has to offer has thus created a very costly health-care responsibility for our government. Problems have mounted as this burgeoning entitle
ment juggernaut consumed those resources that were cre" ated primarily to facilitate combat readiness to defend th|S country. This has led to entitlement inequities that oc& sionally defy logic. Provider and consumer have becofl*e understandably displeased with the result.
Many well-meaning individuals have attempted to b*1 ance these conflicting imperatives and to remedy the s)'s tern’s injustices. To date, regrettably, natural and cosw forces of medical progress and unfettered economic vie'5 situdes have joined forces to oppose all of their efforts'
Programs to deliver military beneficiary health care in a state of turmoil, and the confusion will only gro"' the months ahead. We cannot yet assess the consequent5 of changing the entitlements (or the perceptions of ^ entitlements) heretofore considered inviolate by the *n creasingly frustrated Military Health Services System bel1 eficiaries. Time will judge the value of these efforts-
Captain Smith is Professor of Surgery (Urology) at the Medical Col*0-, of Georgia in Augusta, Georgia, where he is also a medical school l*3, son officer for the Navy Recruiting Command. He received his med,c degree from the University of Maryland School of Medicine in Baitin’0! and did his internship and residency in surgery at the New York Hosp'ta Cornell Medical Center. After a residency in urology at the Colui”^ Presbyterian Medical Center in New York City, he was a fellow in ^ logical cancer surgery at Memorial-Sloan Kettering Cancer Center ^ New York. Captain Smith entered the Navy in 1965 and served n5 surgeon on board the USS Randolph (CVS-15), followed by a tour on surgical service of the U. S. Naval Hospital, Memphis, Tennessee- served as commanding officer of Naval Reserve Medical Contingen. f Response Unit 507 in Charleston and as senior medical officer on ^ staff of Naval Reserve Readiness Command Region Seven in Charles*0. South Carolina. He is currently assigned to the Uniformed Services u versity of the Health Sciences in Bethesda, Maryland, in the depart”'0 of Surgery and Military Medicine. Captain Smith is a previous contf* tor to Proceedings.
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Proceedings / February