Medicare Subvention Demonstration: Greater Access Improved Enrollee Satisfactionbut Raised DOD Costs

摘要

In the Balanced Budget Act (BBA) of 1997, Congress established a 3-yeardemonstration, called Medicare subvention, designed to improve the access of Medicare-eligible military retirees to care at military treatment facilities (MTF). Historically, military retirees age 65 and over have had only limited access to military health care. Until they turned 65, they could enroll in TRICARE Prime, the Department of Defense's (DOD) managed care plan, which gave them priority access to MTFs. Alternatively, they could use one of DOD's other plans that pays part of the cost of civilian health care. However, when they turned 65 and became eligible for Medicare, retirees lost their right to military health care and could obtain care at MTFs only if space were available after higher priority beneficiaries were treated. The demonstration allowed retirees to get their care largely at MTFs by enrolling in a DOD-run Medicare managed care organization known as TRICARE Senior Prime. Enrollees in Senior Prime could receive the full range of Medicare services, as well as some additional TRICARE services, and they would incur minimal out-of-pocket costs. In establishing the subvention demonstration, the BBA also directed us to evaluate the demonstration over its initial 3-year period, which ended in December 2000. Our evaluation covers three major areas: the effect of the demonstration on retirees' access to care and the quality of care received by enrollees; the cost of the demonstration to beneficiaries, Medicare, and DOD; and management and implementation issues encountered during the demonstration. This report, focusing on access to care, is one of several addressing these issues. Our objectives were to examine (1) the effect of the demonstration on enrollees' and nonenrollees' access to health care and (2) the consequences of changes in access to care for retirees' satisfaction, health outcomes, and DOD costs.