THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Wednesday, August 24, 1994 TAG: 9408240542
SECTION: MILITARY NEWS PAGE: A12 EDITION: FINAL
SOURCE: BY LT. CMDR. JOHN TEMPESCO, MEDICAL SERVICE CORPS
LENGTH: Medium: 74 lines
Military health care is changing with the rest of the nation, and many of the changes are confusing. Health maintenance organizations, preferred provider organizations, health alliances, universal coverage, universal access - these and many other new terms make health care difficult to understand during this period of flux.
Each one of these ``doublespeak'' terms refers to a different aspect of managed care. Managed care is a health care management and operational philosophy designed to redirect the focus of health care toward more personalized treatment on the primary care level.
More simply put, the goal is to keep people healthy, rather than care for them when they are sick.
The other major goal of managed care is to control cost. Every day in the news we are bombarded with frightening statistics showing the exponential rise of health care costs. The spiraling cost increases over the past few years have several underlying causes.
First, more and more physicians are choosing specialty fields instead working as general practitioners. Specialists require longer training time and more support staff, and are unable to see as many patients.
Also, medical technology has exploded in the past two decades, meaning that equipment, training and research costs have skyrocketed.
Finally, the way we perceive health care has changed. Person-to-person payment for health care services is no longer the norm in this country. Third-party insurance companies and government agencies now pay the bulk of health care bills. Because the bills are taken care of by somebody else, the recipient of the services no longer worries about how much it costs.
This phenomenon has led to ever increasing use of the health care system, with some overcharging by the system. Rising insurance premiums have conditioned patients to seek out high-tech care from highly specialized providers.
All of these factors have contributed to create an overused, costly health care system in which many members are so heavily worked that they don't have time for the ``personal'' side of medicine.
Over the years, the financial incentives for physicians to specialize beyond primary-care specialties have left most of the nation with too few primary-care physicians (general practitioners, family practitioners, pediatricians, etc.). The ``good old days'' of going to one family doctor for medical care are over.
Tricare, through managed care, seeks to recreate these good old days, while still offering a choice to patients. Through enrolled managed-care programs like Tricare Prime, primary-care providers are directly entrusted with the health care dollars for a specific set of patients. They manage those dollars to provide proactive health care in a manner to reduce their patients' need for illness care.
This relationship allows the health care providers to anticipate needs, personalize care and reduce the frequency and intensity of care required for routine health problems.
When specialty care is needed, the primary care provider continues to be the patient's advocate throughout the specialty care and is also able to follow the patient after the specialty care is no longer needed. Health Care Corner is a monthly feature in Military News. ILLUSTRATION: Graphic
NEED TO KNOW MORE?
For more information on managed care, contact Tricare at any of
these numbers:
Naval Medical Center Portsmouth: 677-6000
Langley Air Force Base: 764-2778
Fort Eustis: 878-7500
KEYWORDS: MILITARY HEALTHCARE by CNB