WASHINGTON, DC—Black non-Hispanics and Hispanics often receive more equitable care under Tricare than in other parts of the US healthcare system, but disparities persist in how they view their health status, according to study published in the July issue of the Journal of the National Medical Association.

The study was commissioned by Tricare to investigate how well the military health system is doing in delivering a uniform health care benefit to beneficiaries in a uniform way. “We are all aiming for that and we are doing it in the context of a very diverse population—a globally deployed population, very mixed in gender, age, and socioeconomic background,” said Thomas V Williams, PhD, director of Tricare’s Health Programs Analysis & Evaluation.

The study included active duty military personnel, retirees, and family members eligible for Tricare who responded to the 2007 Health Care Survey of DoD Beneficiaries. The HCSDB surveys Tricare beneficiaries, asking questions about health status, experiences and perceptions of care, and use of preventive services.

Responses to the 2007 HCSDB were compared with similar data gathered by the 2006 Consumer Assessment of Healthcare Providers and Systems Benchmarking Database for commercial health plans, and with data from the Agency for Healthcare Research and Quality’s 2007 National Healthcare Disparities Report (NHDR).

By comparing disparities in self-reported health status, access to and satisfaction with care, and use of preventive care from the data, investigators sought to find whether patterns of disparities observed within the larger US healthcare system are also present in Tricare.

Providing Preventive Services

The “most pleasant news” of the study, according to Dr Williams, is that MHS was performing well in the delivery of a range of preventive care services for its population in comparison to the national norm.

The study found, for example, that a higher proportion of Tricare beneficiaries across all racial groups reported receiving a colon cancer screening at age 50 or older compared to the US norm. In addition, racial and ethnic minorities in Tricare often reported the same or higher levels of receipt of preventive services than their white counterparts in Tricare. “We wanted to see how we were comparing on some of those items from Healthy People 2010, but we seem to be delivering a preventive health care benefit that is getting to the people we are aiming for,” he said.

Tricare reduces or eliminated many of the copays and deductibles associated with the use of preventive care service. “We are in the middle of a health care debate in this country and we are talking about what are models worth emulating,” said Dr Williams. “I think Tricare has a lot to share in the way that we have promoted access to high quality health care.”

Self Reported Health Differs

A comparison among Tricare active-duty beneficiaries in the study found that a significantly higher proportion of blacks than whites reported no problems finding a personal doctor (63.1%, compared to 52.2%). A significantly larger proportion of black active-duty beneficiaries reported no problems seeing a specialist, compared to whites (61.0%, compared to 55.1%). Compared to whites, significantly higher proportions of black active-duty beneficiaries reported that their doctor listened carefully (87.0%, compared to78.6%).

Despite this, a significantly higher proportion of white active-duty beneficiaries described their health as good or excellent, compared to black active-duty beneficiaries (70.1%). Among retirees, a significantly higher proportion of whites described their health as good or excellent, compared to blacks (48.1%, compared to 40.5%) “Delivering an accessible high quality benefit does not and can not close entirely the apparent entirety of health care needs for beneficiaries,” said Dr Williams. “There are other socioeconomic or racial differences that need to be more fully understood before we can see or expect to see an improvement on self reported health.”

The study stated that the results “suggest that minority active-duty beneficiaries might require more health care services than whites since lower self-rated health has been associated with higher mortality rates and declines in functional ability.”

Further Research

Providers should be pleased that beneficiaries are accessing preventive care programs, but they should also be aware that people have different perceptions of their health status, according to Dr Williams. “Many of our beneficiaries are apparently accessing effective preventive care programs. At the same time, they should be sensitive to the fact that there are significant differences in the way people view their own health,” he said.

It is important that providers are aware of the role that cultural norms play in health. “We would like to think that if we are all wearing the same uniform we think the same way, but we don’t. We don’t eat the same way and we do have our own unique cultures and I think that is worth remaining sensitive to,” he said.

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