Jones adds the benefits for dependents differ little from pre-9/11.
“If anything, there have been increases in coverage of certain things. Telehealth is an example, with increasing capabilities to reach out to active-duty service members and dependents. DOD [the Department of Defense] also added, in August 2014, a Nurse Advice Line that gives all recipients access to expert advice when some of our smaller clinics are not open for urgent care situations,” she said.
There have been recommendations for significant changes in recent years, but to date those have been rejected by Congress. Nor do OTSG 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.
“That changes the scope of what we deliver in our MTF, where we must ensure we deliver the proper scope of care. So if we only deliver a handful of babies a month, it might be better to provide that outside the MTF because our nurses and doctors may not be getting enough continuing experience,” Jones said.
“Most discussion is on cost-share involved in various care. There have been some increases in non-active duty pharmacy fees and increased enrollment fees for TRICARE Prime enrollees under age 65. DOD does not have the authority to make changes in these statutory benefits without the agreement of Congress,” Voelkner said.
Ever-tighter federal budgets and military force downsizing are concerns throughout the services, requiring greater diligence in the use of what funds are available. That also applies to health care, but, so far, not as seriously.
Lt. j.g. Linda Duque, a Neonatal Intensive Care Unit nurse at Naval Medical Center San Diego, checks a newborn. More than 1,000 active-duty and civilian nurses provide patient care throughout the medical center. U.S. Navy photo by Mass Communication Specialist 2nd Class John O’Neill Herrera
“In terms of its effect on medical readiness, that is our primary mission and the last thing that would be affected. So if it hurts anything, it would be the other aspects – beneficiaries and retirees,” Nguyen said.
“Has it affected our ability to deliver care globally? No. Where it has been tightening has been extraneous items, such as funding for providers to go to medical conferences, which has gone away. But, overall, in terms of our focus, we haven’t seen much detriment and, in terms of dependents and retirees, they still get the same level of care and we’ve tried to augment that by rolling out new tools.”
Blast injuries – from severe burns, especially to the face, to amputations – have become a major expansion of military health care in recent years. But not the only one.
“That was another significant change, using case management to keep track of complex patients coming back with multiple conditions – amputations, PTSD, and so on – that we had to learn to address. That changed the shape and development of the Warrior Transition Command, which is associated with the Army Medical Department, but a separate command,” Jones explained.
Operations Iraqi Freedom and Enduring Freedom (OIF and OEF, respectively) also saw a major change in the role of women in the military – and their active duty and subsequent VA health care needs.
The Army’s Soldier Centered Medical Home (SCMH) uses primary care doctors and nurses to provide all-out patient services for active duty personnel, dependents, and retirees.
“It focuses on active duty soldiers; there are two others, one for dependents and one for retirees. The community-based homes, for dependents, tend to be off base, while the other two tend to be located with every military medical facility,” Nguyen said.