Racial and Ethnic Health Disparities in TRICARE by ProQuest


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Racial and Ethnic Health Disparities in TRICARE
Ann D. Bagchi, PhD; Eric Schone, PhD; Patricia Higgins, PhD, MPH; Elder Granger, MD;
S. Ward Casscells, MD; Thomas Croghan, MD


  Background: As a major provider of health care for racial
  and ethnic minority groups, the federal government has
                                                                                        acial and ethnic health disparities have been
  affirmed its commitment to the elimination of health dispari-
                                                                                        described as one of the most serious health care
  ties. Although numerous studies have examined health care
                                                                                        problems in the United States.1 Estimates suggest
  disparities in various federal systems of care, few have exam-
                                                                               that disparities lead to more than 83 000 excess deaths
  ined these issues within TRICARE, the Department of Defense
                                                                               per year among blacks compared with whites.2 Dispari-
  (DoD)’s program for providing health care coverage to
                                                                               ties like these also undermine the core value of equality
  members of the uniformed services and their dependents.
                                                                               in US society.3 Since 2002 publication of the Institute
                                                                               of Medicine’s report, Unequal Treatment, elimination of
  Methods: This study provides an exploratory analysis examin-                 health disparities has become one of the primary goals
  ing apparent disparities in health status, access to and satis-              of the US health care system.1
  faction with care, and use of preventive care using the 2007                     The federal government is a major provider and
  Health Care Survey of DoD Beneficiaries. Analyses compare                    financer of health care for minority populations. In 2001,
  outcomes by race/ethnicity and between TRICARE ben-                          of the 29 million blacks with health insurance, 12 mil-
  eficiaries and national norms derived from the National                      lion were covered by Medicare and Medicaid, and
  Consumer Assessment of Health Plans Study Benchmarking                       another 1 million were covered by the Department of
  Database and the National Healthcare Disparities Report,                     Veterans Affairs (VA) and the Department of Defense
  and are stratified by duty status.                                           (DoD)’s TRICARE program.1
  Results: Compared to black non-Hispanics, a higher propor-                       TRICARE is the DoD’s health care program for those
  tion of white non-Hispanic active-duty and retiree TRICARE                   entitled to health care benefits during or consequent to
  beneficiaries reported good to excellent health status. How-                 service in the armed forces, including active-duty per-
  ever, on most measures, we found no differences between                      sonnel, retired service members, members of the National
  white non-Hispanic beneficiaries and members of racial/                      Guard and National Reserves, and the families of these
  ethnic groups. When differences did exist, minority popula-                  members, as well as survivors and others entitled to
  tions were likely to report better access to and use of ser-                 health care from the DoD. TRICARE provides health
  vices than whites.                                                           insurance coverage through 5 separate programs—
  Conclusions: Although health disparities exist in health status              TRICARE Prime, a managed care option; TRICARE
  and some measures of preventive care, black non-Hispan-                      Extra, a preferred provider option; TRICARE Standard, a
  ics and Hispanics often receive more equitable care under                    fee-for-service option; TRICARE for Life, a supplemen-
  TRICARE than in the nation as a whole. These findings sug-                   tary health care coverage for beneficiaries who are enti-
  gest the need to explore the characteristics of TRICARE that                 tled to Medicare Part A and enrolled in Part B; and TRI-
  may be associated with more-favorable outcomes for racial                    CARE Reserve Select, which provides insurance
  and ethnic minority groups.                                                  coverage similar to TRICARE Standard and Extra to
                                                                               deactivated members of the National Guard and Reserves
  Keywords: health disparities n race/ethnicity                                who purchase it. Beneficiaries receive care either through
                                                                               civilian providers reimbursed by TRICARE (known as
  J Natl Med Assoc. 2009;101:663-670
                                                                               purchased care) or from hospitals and clinics operated
                                                                               by the uniformed services (known as direct care).
Author Affiliations: Mathematica Policy Research Inc, Princeton, New Jersey
(Dr Bagchi, senior researcher); Mathematica Policy Research Inc, Wash-
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