Defense Health Care: Resources, Patient Access, and Challenges in Europe and the Pacific

According to a recent Air Force study, the fleet of dedicated C-9 aircraft used for aeromedical evacuation needed to be replaced. DOD has identified and pursued several alternatives to using the C-9 airframe for transporting overseas patients needing care not available locally. Specifically DOD has (1) increased the space for patients on scheduled cargo plane missions to the U.S., (2) increased the use of opportune aircraft or commercial alternatives, and (3) pursued using the C-21 airframe equipped with medical capability as a full substitute for the C-9 airframe.

DOD agreed that the medical screening processes for overseas active duty members and their families should ensure that they do not have medical problems exceeding the capabilities of military treatment facilities and health providers overseas. DOD stated that it is closely monitoring active duty members and their families to ensure that the screenings accurately disclose their medical conditions. DOD further acknowledged that medical screenings for civilian employees are also important to ensure that overseas facilities have the capability to address their medical needs. In a June 2002 notification, DOD discussed its current policy that requires civilian employees who have been notified that they have been selected for a foreign area position to be medically screened, and to meet the physical requirements for the position prior to an employment commitment.

On July 30, 2001, DOD issued to the Surgeons General of the Army, Navy, and Air Force, and to the Director of Health and Safety of the Coast Guard, a letter reemphasizing that overseas Prime enrollees are allowed to obtain civilian care as needed without preauthorization while traveling in the U.S. Also reemphasized was that beneficiaries enrolled in TRICARE Prime have priority access for care ahead of non-enrolled beneficiaries in all military treatment facilities.

DOD now has policies in place to expand the use of host nation medical providers for overseas patients, and plans to continue seeking opportunities to do more in this important area given the decade-long reductions in military medical personnel overseas. In addition, DOD has implemented a formal mechanism to give feedback to host nation providers on care quality. DOD introduced the formal feedback process in Europe in February 2001, and in the Pacific in September 2001.