Evolution of Tricare in the United States Central Command's Area of Responsibility: An Interagency Success Story

摘要

The delivery of quality health care at an affordable price is a challenge at any time, even within the borders of the continental United States. The challenge of delivering affordable quality health care to military beneficiaries outside the borders of the United States, particularly in remote and third world locations, is a daunting task. TRICARE is the instrument designated by Congress to provide health care worldwide to the members of the armed forces and their families. In the United States Central Command's (CENTCOM) area of responsibility (AOR) there are some of the remotest, inhospitable, and backward countries imaginable where, if health care exists at all, it does not meet the standard of western medicine. TRICARE was to remedy this problem for our service members and their families, but failed. From July 1999 through August 2001, the CENTCOM Surgeon's office, TRICARE Europe, and the Office of the Secretary of Defense for Health Affairs were engaged in an attempt to remedy the failed TRICARE system. During this two-year period, personalities, governmental politics, organizational culture, and process inertia stalled the effort to provide quality health care to our beneficiaries. It took the threat of personal intervention from the Commander in Chief of the United States Central Command via a 'personal for' message to the Deputy Secretary of Defense for Health Affairs to galvanize the interagency process to successfully design and implement a solution that now provides quality health care at an affordable price to members of the armed forces at remote CENTCOM locations. This paper is the story of the initially failing interagency process and the ultimately successful interagency process.