Department of Veterans Affairs (VA) scandals, attempts to increase TRICARE costs to patients, especially prescriptions, reductions in numbers of active-duty service members combined with tight budgets, and the highest number of new veterans relying on VA medical care since Vietnam have raised concerns throughout the military and veteran communities about the future of health care for them and their dependents.

Both military and VA officials insist overall care actually is improving, despite some high-profile glitches in recent years.

One of the most public complaints with respect to VA medical services in recent years has been long wait times to secure appointments. That is not only a VA issue, however. Maj. Vu Q. Nguyen, program manager of the Primary Care Service Line at the U.S. Army Medical Command (MEDCOM) Soldier-Centered Medical Home at Joint Base San Antonio, Texas, said it “remains an issue for all the services.”

“We understand the issues facing the VA, but we are trying to provide multiple options for our patients. It’s not an easy problem, but is less of an issue for our active-duty population. If a clinic has 10 patients, half active duty, those five would be pushed to the front for care. Retirees and dependents would be seen by network providers, where necessary. We call it a ‘pop-off valve’ – if we are short on providers for whatever reason, we will allow more patients than usual to be seen by the network,” he said.

“A lot of that is due to the increase in our beneficiary population due to the past years of war. But making sure our soldiers and dependents are seen always has been and remains a primary focus, whether [they are seen by] civilian providers or those working for us. Certain locations are healthy enough to handle that, but in some others, we depend heavily on active-duty providers. But for all intents and purposes, we do meet care needs, including the use of the Nurse Advice Line, online scheduling, and other avenues where the patient can reach out.”

Both military and VA officials insist overall care actually is improving, despite some high-profile glitches in recent years.

“Since 2001, new programs have been added, including TRICARE for Life, TRICARE Reserve Select, and TRICARE Retired Reserve, as well as ramping up coverage in behavioral health,” according to Bill Voelkner, program analyst for Health Plan Management in the Office of the Army Surgeon General (OTSG). “So Congress has allocated additional benefits in statutory TRICARE benefits in this time frame.

“Active duty receive the bulk of their care in the MTF – Military Treatment Facility or direct care – or network providers; dependents have the option of standard [intraservice] or TRICARE Extra or TRICARE Prime. In Extra, costs are a little less because they see network providers; Standard gives access to out-of-network providers. There is never a cost for active duty, but there may be for dependents, depending on what care they use.”

Managed by the Defense Health Agency under the Assistant Secretary of Defense (Health Affairs), TRICARE provides health care services for almost 9.5 million beneficiaries worldwide. That includes active duty members of all seven U.S. uniformed services – Army, Navy, Air Force, Marine Corps, Coast Guard, Commissioned Corps of the U.S. Public Health Service, and the National Oceanic and Atmospheric Administration – National Guard and Reserve service members, retirees, their families, survivors, certain former spouses, and others registered in the Defense Enrollment Eligibility Reporting System (DEERS).

TRICARE was phased into existence between 1994 and 1997 as a replacement for CHAMPUS (Civilian Health and Medical Program of the Uniformed Services), which had been in effect since 1966. Since then, it has gone through a number of reorganizations, until today it comes in a wide range of program options for health care, dental, and pharmaceutical services (See sidebar at the end of this article).

There have been recommendations for significant changes in recent years, but to date those have been rejected by Congress. Nor do Office of the Army Surgeon General officials expect any major changes in direct coverage or benefits in the next five to 10 years, although increased cost scrutiny and planned reductions in the size of the military services could have impacts.

“It’s a very robust plan compared to the coverage of other health care plans, especially in terms of the cost to the recipient. What we have attempted to do, as we draw down, is pay close attention to maintain our medical capabilities to support future conflicts. So as some of our MTFs get smaller and we are unable to maintain the skill sets of all our military providers, we are looking to put them into those facilities that will maintain their skills and abilities,” Lt. Col. Tammie Jones, OTSG Senior Health Policy Officer, said.

“There is scrutiny from all levels to make sure we are running an efficient health care operation. We run routine performance reviews against national standards, evaluating quality and effectiveness of the care we deliver. We’ve also looked at where we have health care facilities and make sure there is still a need to deliver what has been historically delivered at each of those and where we may have less need for the type of care we have been giving as units have moved from one base to another, for example.”