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Practical Lessons for Health Care Reform from the Military Health System

New Issue Brief from Mathematica Notes that Universal Coverage Alone Will Not Address Health Care Disparities

Contact: Cheryl Pedersen, (609) 275-2258

WASHINGTON, D.C. (December 2, 2009)—Many current health reform proposals focus on universal coverage, insurance reform, and cost control. A new issue brief from Mathematica Policy Research presents findings from its study of the military health system (MHS) that have timely implications for health care reform. The findings suggest that universal coverage alone is unlikely to solve many of the problems in our current system without other changes. While universal coverage represents a critical step to improving health care in the United States, the research suggests that other actions, such as strengthening primary care and public health initiatives, will also be necessary to solve these problems.

The Department of Defense (DoD) operates one of the largest health care systems in the nation, covering more than 9.5 million active duty, retiree, and dependent beneficiaries. The military health system seeks to provide equitable, high quality, affordable health care to a diverse population while reducing spiraling costs. To achieve its mission, the MHS delivers medical care through a network of military clinics and hospitals as well as more than 1,700 acute care civilian hospitals, 300,000 civilian physicians, and 60,000 pharmacies across the globe.

Innovation in the military system’s delivery of health care is relevant to both public and private insurers. Because the military system is government-run, the following lessons from Mathematica’s study are relevant to the “public option” being debated as part of health care reform:

  • Universal coverage alone will not solve health care disparities. Research shows that significant racial and ethnic disparities in child health exist across the country, particularly in the prevalence, treatment, and outcomes of children with asthma. Our study found that for the cohort of children enrolled in the MHS in 2007, universal comprehensive coverage did not eliminate racial and ethnic disparities in health care for children with asthma.

  • Expectations need to be aligned with experiences. Having a regular source of treatment from a primary care provider is an important factor in patient experiences and perceptions. Mathematica’s survey showed that DoD beneficiaries’ satisfaction with getting timely care when needed was significantly lower than that of civilian beneficiaries. In focus groups, active duty dependents, retirees, and retiree dependents noted that provider choice was a key component of their experiences. Many felt their options were severely limited, which significantly reduced their satisfaction. These findings are consistent with studies of primary care “gatekeeper” models demonstrating that a lack of choice erodes the trust necessary for a patient to establish an ongoing relationship with a doctor.

  • Strengthening primary care could improve access to and satisfaction with health care. Continuity of care and access to physicians are central factors in  how patients perceive their health care experiences.
“Even if current health care proposals focused on universal coverage, insurance reform, and cost control are successful, some of the most vexing problems in the current system are likely to persist,” said Thomas Croghan, M.D., the report’s lead author and a senior researcher at Mathematica. “Policymakers must continue to address important issues such as racial and ethnic disparities, timely access to needed care, and dissatisfaction with care received.”

“Practical Lessons for Health Reform from the Military Health System,” by Croghan, Kristen Purcell, and Kate Stewart is available at

Mathematica Policy Research, a nonpartisan research firm, provides a full range of research and data collection services, including program evaluation and policy research, survey design and data collection, research assessment and interpretation, and  program performance/data management, to improve public well-being. Its clients include federal and state governments, foundations, and private-sector and international organizations. The employee-owned company, with offices in Princeton, N.J., Ann Arbor, Mich., Cambridge, Mass., Chicago, Ill., Oakland, Calif., and Washington, D.C., has conducted some of the most important studies of health care, education, family support, employment, nutrition, and early childhood policies and programs.