04189cam a2200457 i 4500001001900000003000500019008004100024010001600065020001500081027002100096035002000117037001100137040001900148043001200167050002100179100003100200245015100231264003700382300004500419336002600464337002600490337002800516338003600544338002700580500004300607500010100650500011400751504004100865520223400906530005803140588004703198610009303245650005403338700002903392700003403421710003803455710004703493710004803540710008203588856006103670rnd000000000093794RAND941103s1994    caua          000 0 eng d  a   92046776  a0833015702  aRAND/R-4244/6-HA  a(Sirsi) a366892  c$30.00  aCstmoRcCstmoR  an-us---00aUB403b.S58 19941 aAnderson, Mary E.eauthor.10aEvaluation of the CHAMPUS Reform Initiative.nVol. 6,pImplementation and operations /cMary E. Anderson, Susan D. Hosek with Ellyn S. Bloomfield. 1aSanta Monica, CA :bRAND,c1994.  axiii, 78 pages :billustrations ;c28 cm  atextbtxt2rdacontent  acomputerbc2rdamedia  aunmediatedbn2rdamedia  aonline resourcebcr2rdacarrier  avolumebnc2rdacarrier  a"National Defense Research Institute."  aThis is the sixth volume in a series of 6 reports from the CHAMPUS Reform Initiative evaluation.  aThis project "conducted ... by RAND's Health Sciences Program and Defense Manpower Research Center"--Preface.  aIncludes bibliographical references.  aHealth care utilization and costs under managed care are evaluated in this report. As part of the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) Reform Initiative (CRI) demonstration, conducted from 1988 to 1993 in California and Hawaii, this report includes estimates of the effects of CRI on utilization levels and costs for CHAMPUS beneficiaries. It also explores differences within CRI between beneficiaries who elected to enroll in CHAMPUS Prime, an HMO option offered by CRI, and those who did not enroll. The authors conducted two mail surveys of CHAMPUS beneficiaries, (beneficiaries include dependents of active-duty military personnel, and retired military personnel and their dependents) one shortly before CRI began and another two years later. They then compared data from both surveys in the eleven military hospital catchment areas with eleven matched control areas in different states. 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. First-dollar coverage in Prime increased the costs of care that would have been used even without CRI, thereby adding to the amount of care demanded. The cost containment features in CRI, such as utilization review, were not able to counteract the added costs in Prime and the higher administrative overhead for the program.  aAlso available on the internet via WWW in PDF format.  aDescription based on print version record.10aUnited States.bOffice of Civilian Health and Medical Program of the Uniformed Services. 0aMilitary dependentsxMedical carezUnited States.1 aHosek, Susan D.eauthor.1 aBloomfield, Ellyn S.eauthor.2 aDefense Manpower Research Center.2 aNational Defense Research Institute (U.S.)2 aRand Corporation.bHealth Sciences Program.1 aUnited States.bOffice of the Assistant Secretary of Defense (Health Affairs)41yOnline Accessuhttp://www.rand.org/pubs/reports/R4244.6/