Too many beneficiaries of the military direct-care health system still can’t get timely appointments, or reach doctors after hours, or establish a close family-doctor relationship with a single military physician or group.

For these reasons and more , Army Maj. Gen. (Dr.) Elder Granger, deputy director of TRICARE and a principal advisor within the Department of Defense on health policy and performance, gave the military health system an overall grade of “C plus or B minus” in an interview with Military Update.

In fiscal 2008, the number of civilian providers accepting TRICARE patients grew by 115,000 to reach 1.1 million nationwide.

Users of military hospital and clinics, he said, too often face telephone busy signals in trying to make appointments. He wants more consistency in administrative support, from how phones are answered to how appointments are booked, from how providers are reached after hours to how health readiness is tracked and preventive care services are offered.

“How do you get to your primary care provider after hours?  That’s a challenge we continue to work,” Granger said. “That’s why I’m being honest about this C+ or B-.”

There is uneven support online in the system, and improvements needed with electronic records, Granger said. He wants more emphasis too on disease prevention and measuring performance among health providers

How does a patient reach a military physician after hours?

“Well, it varies,” Granger said. “Some places will say ‘Go to the emergency room.’ Some will say, ‘Call this number.’ Some will say ‘Call the hospital and get the administrative officer of the day.’ 

“It’s not a consistent process. Yet our policy says we must take care of you 7-24-365. That’s why I’m being a little hard on us because we’ve got to get that under control.”

Every year more beneficiaries migrate from base hospitals and clinics to networks of civilian physicians under contract to TRICARE. 

The migration is seen in enrollments figures for TRICARE Prime, the managed care option. 

Since October 2003, the number of enrollees with civilian doctors has doubled, from 600,000 to 1.2 million while enrollees in military direct care have fallen by roughly 300,000 to stand below 3 million.

Patient workloads show a sharper drop. The number of inpatients in military hospitals in 2008 was 30,000 below the 2003 total, even as the beneficiary population grew, yet the number of military beneficiaries with stays in civilian hospitals rose by 80,000.

Walk-in visits to military facilities in 2008 were a million down from the 30 million reported in 2003. Meanwhile, military patient visits to civilian contract doctor climbed from 24 million in ’03 to nearly 40 million in ’08.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at: milupdate@aol.com