Understanding Patterns of Purchased Care and Direct Care Utilization Among TRICARE BeneficiariesObjective: Follow-on to the Consortium study will describe the types of services that are more and less likely to gravitate to the TRICARE purchased care, and the characteristics of individuals who are more or less likely to use TRICARE network providers relative to direct care providers. This study will examine patterns of TRICARE network utilization relative to MTF utilization for select categories of service and/or conditions among TRICARE Prime beneficiaries under age 65.
Results: We found that pharmacy and cardiovascular services were most likely to occur in the purchased care setting. Contrary to expectations, we found that services that may have social stigma, including HIV, mental health and alcohol/drug abuse, occur in relatively similar proportions in the direct and purchased care settings. There was a relatively consistent pattern of purchased care use within the nonelderly beneficiaries in this study. Perhaps the structural characteristics were the most revealing determinants of purchased care. For example, higher levels of military service availability were typically associated with a ‘pull’ to direct care, although similar measures in the civilian health system did not seem to strongly attract patients to purchased care. As hypothesized, Global War on Terrorism (GWOT) deployments were correlated with higher levels of use of purchased care services. Finally, purchased care or direct care was not consistently more expensive than the other. For Prime enrollees, users of the combination of direct/purchased care were substantially more expensive than those using direct care only, however, Prime enrollees using purchased care only were less expensive than those using direct care only. The relationship was more consistent for non-Prime beneficiaries where purchased care only and purchased/direct care users were more expensive than direct care only users.