To inform improvements to the quality of care delivered by the military health system for posttraumatic stress disorder and major depressive disorder, researchers developed a framework and identified, developed, and described a candidate set of measures for monitoring, assessing, and improving the quality of care. This document describes their research approach and the measure sets that they identified.

As a step toward improving its health information technology (IT) interoperability, the Military Health System is seeking to develop a research roadmap to better coordinate health IT research efforts, address IT capability gaps, and reduce programmatic risk for its enterprise projects. This report identifies gaps in research, policy, and practice involving patient privacy, consent, and identity management that need to be addressed to improve the quality and efficiency of care through health information exchange.

Since the military draft ended in 1975, newly commissioned officers haveincluded increasing numbers of minorities and women. These officers must beretained and promoted for the senior officer ranks to become as diverse asthe junior officer ranks are today. This report examines whether minorityand women officers obtain these promotions and choose to continue in theircareers at the same rate as other officers. The authors conducted tworesearch efforts: analyzing personnel records and interviewing midcareerofficers, personnel managers, and promotion board members individually andin focus groups. Results for minorities other than blacks were limited dueto small sample sizes. White women were found to be less likely to reachhigher officer ranks than were men, mostly because they chose to leave themilitary between promotions. Black male and black female officers generallyfailed promotions in higher proportions than did white males, but were morelikely to stay in the military between promotions. The interviews and focusgroups revealed different perceptions about careers: Black officers seemedto have greater difficulty forming all-important peer and mentorrelationships and overcoming initial expectations of lower performance.Women's careers have been affected by limited occupational opportunities,inconsistent acceptance of their role as military officers, harassment, andfamily conflicts.

For a number of reasons, military beneficiaries--active-duty service members, military retirees, and their dependents--are heavier users of medical care than are comparable civilian populations. These services are currently provided by military treatment facilities (MTFs) or the civilian medical facilities, the latter through the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). However, over the past several years, the system has faced the twin challenges of downsizing in consonance with the rest of the Department of Defense and of controlling escalating health care costs. While care provided in the civilian sector can be more expensive than that provided in the MTFs, the free care available in MTFs sparks greater demand. Moreover, the MTF system was designed to meet wartime, rather than peacetime needs. In weighing the pros and cons of various alternatives, this report suggests that beneficiaries might prefer civilian health plans, as long as there is no erosion of benefits in making such a shift.

Using data from five employers who were among the first to offer their employees preferred provider organization (PPO) options, this study estimates the PPOs' effects on participants' use of health care services in general and mental health care services in particular. The employers offered different incentives to use PPO providers: two waived all cost-sharing, one waived the deductible, one waived the coinsurance, and one cut the coinsurance for physician services in half. Unlike some other PPO plans, however, none covered additional services in the PPO. The research was based on data from personnel records, medical claims records, and an employee survey. Approximately two years after the PPO options were first offered, they had attracted 24-65 percent of the employees and covered dependents enrolled in indemnity plans. Among users, there was a consistent pattern of lower levels of use, as measured by total charges and reimbursements. Only three employee groups were large enough to warrant a separate analysis for mental health services. In the first post-PPO year, two of the three groups showed a lower propensity to use mental health services in the PPO, but the difference all but disappeared by the second year.

"Women with disabilities, a large and growing segment of the U.S. population, are as a group underserved in primary health care services that are appropriate to their needs. To date, few (if any) formal studies have been done examining the short- term costs or long-term benefits of providing specialized care for these women. This paper describes the major financial issues affecting access to appropriate primary health care for women with disabilities. The assessment is based on a review of the published literature, supplemented by key stakeholder interviews, and covers issues that are relevant at the national level and in southwestern Pennsylvania specifically. The findings and recommendations should be of interest to public and private decisionmakers seeking to improve access to health care for women with disabilities"--P. iii.

"The dependents of active-duty personnel and members of military retirees' families receive health care from Military Treatment Facilities (MTFs) and from civilian providers under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). Like other health insurance programs, CHAMPUS has experienced rapidly increasing costs. In addition, beneficiaries have expressed dissatisfaction with aspects of both CHAMPUS and the MTFs, including access to care, continuity of care, and CHAMPUS benefits and paperwork. Before implementing a nationwide program of reforms designed to correct these problems, the Assistant Secretary of Defense for Health Affairs will conduct a demonstration. This Note describes a plan for evaluating this demonstration. The evaluation will describe the methods followed by each contractor in implementing the CHAMPUS Reform Initiative (CRI), identify problems uncovered by the demonstration, estimate the effectiveness of CRI in achieving its goals, and recommend changes in the program to enhance its effectiveness.--Rand abstracts.

The authors found that for the average adult beneficiary, costs to the government were 9 percent higher with CRI. Compared to the non-CRI program, costs were 57 percent higher for Prime enrollees, whereas they were the same for non-enrollees. Prime enrollees' use of outpatient care accounted for almost all of the utilization increase in CRI. Active-duty spouses who enrolled did not change their military treatment facility (MTF) use, but they were more likely to augment their (MTF) care with civilian care. Retired enrollees were more likely to use both MTF care and civilian care. CHAMPUS inpatient utilization was lower in CRI, as is often the case in managed-care programs, whereas use of MTF inpatient services did not change significantly. These findings suggest that CRI was able to increase access, especially to civilian care, with an accompanying increase in costs. The evidence points to high utilization among Prime enrollees, especially for retired beneficiaries.