August 05, 2019
By Lisa Rapaport
(Reuters Health) - American families with military health insurance may be more likely to experience difficulties with access to healthcare than civilian families with other types of medical benefits, a U.S. study suggests.
Researchers examined survey data collected from families of 84,783 children under age 18 from 2007 to 2015. About 2% of the kids had insurance through Tricare, the U.S. health program for service members and their families; another 37% were covered by other government health programs like Medicaid; 51% had private health insurance; and 10% were uninsured.
Overall, kids covered by Tricare were more likely to have a usual source of care than children with other types of benefits. But children with special needs and kids with behavioral health problems appeared to have less access to care with Tricare than with other types of coverage.
"Optimum care of children with special healthcare needs hinges upon a well-integrated system and continuity of care," said Dr. Muhammad Ali Chaudhary, a researcher at Brigham and Women's Hospital and Harvard Medical School in Boston who wasn't involved in the study.
"Relocation, a common phenomenon in military families, is associated with disruption of care and the need for re-establishment of care in the new location," Chaudhary said by email. "This may prevent these patients from getting the integrated healthcare experience that they need."
TRICARE is one the largest integrated healthcare system in the Unites States, with more than 9 million beneficiaries. Prior studies have shown a lack of racial disparities in surgical, obstetrics and trauma and pediatric trauma patients, owing to the universal insurance and equal access system of TRICARE.
More than 1.7 million children nationwide were eligible for Tricare as of 2016, with at least one parent in the military including active duty and selected reserve members, Dr. David Rubin of the Children's Hospital of Philadelphia and colleagues write in Health Affairs, in an article published online August 5.
While Tricare provides near-universal coverage through a system that combines military treatment facilities and civilian care, military families can still face a unique set of challenges that color how they perceive the availability and quality of pediatric care.
Typical kids who don't have chronic physical health issues may indeed have an easier time getting care through Tricare than with other insurance, some previous research has found.
The current study, however, which looked at parents' perceptions about the access and quality of care available to their children, suggests that the picture may look different for kids with complex physical, mental or behavioral health issues.
Only about one-third of parents who had kids in Tricare reported that their child's usual provider had hours at night or on weekends or was easy to contact after hours. This was similar for uninsured kids or children with public health insurance, but lagged behind kids with private health insurance, half of whom could see or contact a provider after hours.
"It's possible that the offices that children in Tricare receive care through are less accessible, but it is also possible that parents don't know whether their child's office offers these options," said Dr. Joe Zickafoose, a senior researcher with Mathematica and a primary care pediatrician at Vanderbilt University Medical Center in Nashville, Tennessee.
Zickafoose wasn't involved in this study but coauthored a separate study published in the same issue of Health Affairs that compared children's benefits under Tricare, Medicaid, and marketplace plans.
Children in Tricare were more likely to have multiple special health care needs or behavioral health problems than children with other types of benefits or kids who were uninsured, the current study found. And kids with the most special health care needs and children with behavioral health problems in Tricare also faced the most challenges getting routine appointments.
"There hasn't really been a direct comparison of these challenges between children in military families and children with other types of coverage," Zickafoose said. "These types of comparisons are important to understand how much the challenges children in Tricare face are general deficiencies in care in the U.S. versus issues more specific to children in military families."
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