000			04189cam a2200457 i 4500
001			rnd000000000093794
003			RAND
008			941103s1994 caua 000 0 eng d
010			_a 92046776
020			_a0833015702
027			_aRAND/R-4244/6-HA
035			_a(Sirsi) a366892
037			_c$30.00
040			_aCstmoR _cCstmoR
043			_an-us---
050	0	0	_aUB403 _b.S58 1994
100	1		_aAnderson, Mary E. _eauthor.
245	1	0	_aEvaluation of the CHAMPUS Reform Initiative. _nVol. 6, _pImplementation and operations / _cMary E. Anderson, Susan D. Hosek with Ellyn S. Bloomfield.
264		1	_aSanta Monica, CA : _bRAND, _c1994.
300			_axiii, 78 pages : _billustrations ; _c28 cm
336			_atext _btxt _2rdacontent
337			_acomputer _bc _2rdamedia
337			_aunmediated _bn _2rdamedia
338			_aonline resource _bcr _2rdacarrier
338			_avolume _bnc _2rdacarrier
500			_a"National Defense Research Institute."
500			_aThis is the sixth volume in a series of 6 reports from the CHAMPUS Reform Initiative evaluation.
500			_aThis project "conducted ... by RAND's Health Sciences Program and Defense Manpower Research Center"--Preface.
504			_aIncludes bibliographical references.
520			_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.
530			_aAlso available on the internet via WWW in PDF format.
588			_aDescription based on print version record.
610	1	0	_aUnited States. _bOffice of Civilian Health and Medical Program of the Uniformed Services.
650		0	_aMilitary dependents _xMedical care _zUnited States.
700	1		_aHosek, Susan D. _eauthor.
700	1		_aBloomfield, Ellyn S. _eauthor.
710	2		_aDefense Manpower Research Center.
710	2		_aNational Defense Research Institute (U.S.)
710	2		_aRand Corporation. _bHealth Sciences Program.
710	1		_aUnited States. _bOffice of the Assistant Secretary of Defense (Health Affairs)
856	4	1	_yOnline Access _uhttp://www.rand.org/pubs/reports/R4244.6/
999			_c597982 _d597982