The Dual Eligible Beneficiary Population: An Analysis of The Treatment of Medicare/DoD Eligible Patients at Tripler Army Medical Center.
Final rept. Jul 95-Jul 96,
ACADEMY OF HEALTH SCIENCES (ARMY) FORT SAM HOUSTON TX HEALTH CARE ADMINISTRATI ON
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The Department of Defense has developed a comprehensive managed care program known as TRICARE. The goals of this program are to increase efficiency and cost-effectiveness of CHAMPUS and direct care services through established networks of high-quality civilian providers and hospitals, and improving beneficiary services by providing enhanced access to care. An issue that has Spurred many a debate is that of access to care for the dual eligible MedicareDoD population. Currently, there is no mechanism for this beneficiary population to enroll in TRICARE. It is estimated that as space available care decreases in the Military Treatment Facilities, they will have to seek care on their own in the civilian sector. A goal of DoD is to be authorized nationwide as a Medicare reimbursable provider, a policy known as Medicare Subvention. Under Medicare Subvention, DoD will be given funding to provide care to Medicare eligible beneficiaries who want to continue to receive care under the Military Health Services System. This policy is currently under review in Congress. The purpose of this project was to present a utilization and demographic analysis of the MedicareDoD eligible population for Tripler Army Medical Center. In addition, two reimbursement methodologies, a prospective payment and capitation system, were applied to review the revenue that could have been generated for FY 1994 and 1995 if Medicare Subvention were passed. This project will serve as a baseline for further analysis if and when Medicare Subvention becomes a reality.
- Economics and Cost Analysis
- Medicine and Medical Research
- Medical Facilities, Equipment and Supplies