United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1996-05-13 monographic deposited born digital 42 p. GA 1.13:HEHS-96-141 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-96-141 P0b002ee180379033 f:he96141 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-96-141 machine generated eng fdlp REPORT GAOREPORTS-HEHS-96-141 HEHS-96-141 Health care programs Cost sharing (finance) Medical economic analysis Hospitals Medical services rates Retired military personnel Military dependents Surveys Public Health Service facilities Managed health care DOD Uniformed Services Treatment Facilities Program DOD TRICARE Program DOD TRICARE Standard Program Civilian Health and Medical Program of the Uniformed Services CHAMPUS DOD Military Health Services System Federal Employees Health Benefits Program Letter Report HEHS

Pursuant to a legislative requirement, GAO reviewed the potential effects of the Department of Defense's (DOD) new health care benefit and cost-sharing package, which is part of its TRICARE managed health care program, on the Uniformed Services Treatment Facilities (USTF).<p/>GAO found that: (1) the new cost-sharing arrangement might leave USTF at risk for higher costs by causing some healthy members to disenroll, an outcome known as adverse selection; (2) adverse selection probably will not have long-term negative financial effects on USTF, because less than 10 percent of current USTF members are expected to disenroll, and USTF costs would not increase by more than 2 percent; (3) DOD capitation payments will automatically adjust for higher USTF costs caused by changes in enrollment, and USTF may negotiate payment adjustments for the effects of the benefit and cost-sharing revisions; (4) USTF estimated that cost-sharing would cause about 40 percent of their members to disenroll and increase costs by about 11 percent; (5) the USTF estimates are unreliable because of data and methodological weaknesses; (6) the USTF estimates included data for large claims which are unpredictable and dramatically affect cost estimates; (7) the difference in members' out-of-pocket costs between USTF and TRICARE Standard is not expected to be great enough to cause more than an estimated 10-percent USTF disenrollment; and (8) USTF already serve proportionally more retirees and their dependents who are under age 65 than exist in the general DOD population, but cost-sharing may reduce the proportion of younger retirees and their dependents in the USTF population. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-96-141/html/GAOREPORTS-HEHS-96-141.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-96-141/pdf/GAOREPORTS-HEHS-96-141.pdf GAO/HEHS-96-141 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-96-141 Letter Report GAO/HEHS-96-141; Defense Health Care: Effects of Mandated Cost Sharing on Uniformed Services Treatment Facilities Likely to Be Minor; Health care programs Cost sharing (finance) Medical economic analysis Hospitals Medical services rates Retired military personnel Military dependents Surveys Public Health Service facilities Managed health care DOD Uniformed Services Treatment Facilities Program DOD TRICARE Program DOD TRICARE Standard Program Civilian Health and Medical Program of the Uniformed Services CHAMPUS DOD Military Health Services System Federal Employees Health Benefits Program Title 42 Section 248c 42 U.S.C. 248c Public Law 104-106