COMMENTARY >> Tricare: benefit or entitlement?

By Col. James Carroll
314th Medical Group commander

It’s been three years since I took command of the 314th Medical Group, and in that time I have seen some amazing changes in the medical group and the wing.

We have effectively transitioned the facility from a hospital structure into a state of the art medical clinic. After $23 million in renovations, with another $7 million still to be started, the clinic has become an attractive place to work and recruit. I say recruit because if you have not noticed, we have added a substantial number of civilian providers to our staff, effectively replacing our active duty providers.

This is the wave of the future for the Air Force Medical Service, because of the nationwide provider shortage and the push to have active-duty providers in full time deployable billets, which are now at major Air Force hospitals.

One challenge we face is with our most treasured Department of Defense benefit – Tricare. We have some fantastic personnel running our Tricare Service Center and our Tricare Operations and Administration Flight, but they constantly have to remind us all of how fragile this benefit has become. Most active-duty members see Tricare as an entitlement, a government program which guarantees and provides benefits to a particular group, versus what it truly is, a benefit, something that promotes or enhances well-being to beneficiaries that pay into a fund or policy. Whereas an entitlement like Medicare is guaranteed to those who reach a certain age in this country; the Tricare benefit given to active-duty members and their families has to be managed fiscally and morally or else it will be bankrupt and disappear as a benefit.

My concern is with the misuse, or possible abuse, of our Tricare benefit to detriment of all beneficiaries. Specifically, I am talking about misuse by those that expect Tricare to approve non-traditional treatments for disease protocols.

This includes experimental medical treatments, advanced radiography, experimental drug protocols and excessive provider visitations, defined as more than 12 visits per year, not including well-baby visits.

Like any other insurance policy, Tricare has limitations with money and services, and when the requirements outpace the resources, the benefits get more costly and have to be shared amongst its beneficiary population.

The Air Force Medical Service has tried to mitigate many inherent cost increases to our Tricare benefit by providing generic drugs in our pharmacy, questioning atypical prescriptions written by downtown providers, limiting the type of care and number of visits received with referrals to downtown providers, dispensing vaccinations only when needed for specific overseas locations, asking for co-pays on special “designer” drugs and trying to stress home care versus emergency room visits for minor medical problems.

While most of the measures are making a difference, many military beneficiaries still may not understand the reasons for them or resist the changes made over the past 20 years to our medical benefits. These changes have all been made with the service member and his/her family in mind and to ensure the survival of our robust medical benefit.

Bottom line: Like any benefit, if it gets misused or abused, it will disappear! Tricare has been rated the number one healthcare benefit of any corporation in the U.S. for service and cost-benefit ratios. If we want to keep it the best benefit, we all have to be good stewards of our money by keeping costs down and quality up.

So just because the Internet gives you the “knowledge” to question the care given to you by your doctor, pharmacist or Tricare administrator, you need to trust the “experts” who know the rules, benefits and limitations of Tricare. Help us protect one of our most valuable benefits – Tricare!