COMPREHENSIVE STUDY OF THE MILITARY MEDICAL CARE SYSTEM.

SEC. 733. COMPREHENSIVE STUDY OF THE MILITARY MEDICAL CARE SYSTEM. (a) Requirement for Study and Report.—The Secretary of Defense shall conduct a comprehensive study of the military medical care system. Not later than December 15, 1992, the Secretary shall submit to the congressional defense committees a detailed accounting on the progress of the study, including preliminary results of the study. Not later than December 15, 1993, the Secretary shall submit to the congressional defense committees a final report on the study. (b) Elements of Study.—The Secretary of Defense shall include as part of the study required by subsection (a) the following: (1) A systematic review of the military medical care system required to support the Armed Forces during a war or other conflict and any adjustments to that system required to provide cost-effective health care in peacetime to covered beneficiaries. (2) A comprehensive review of the existing methods of providing health and dental care through civilian health and dental care programs that are available as alternatives to the methods for providing such care through the existing military medical care system, including the cost and quality results of experimental use of such alternative methods by the Secretary and 105 STAT. 1409the level of satisfaction of the persons who have received health or dental care under such alternative methods. (c) Survey.—The study required by subsection (a) shall also include a survey of members of the Armed Forces and covered beneficiaries in order to— (1) determine their access to and use of inpatient and out-patient health care services in the military medical care system— (A) by source of care and source of payment, including private sector health insurance; and (B) in relation to civilian sector standards established for particular clinical services; and (2) determine their attitudes and the extent of their knowledge regarding— (A) the quality and availability of health and dental care under the military medical care system; (B) their freedom of choice with respect to health care providers and level of health care benefits; (C) the premiums, fees, copayments, and other charges imposed under the military medical care system; and (D) any changes in the rules, regulations or charges that characterize the military medical care system. (d) Content of Report.—The report required by subsection (a) shall include with respect to the systematic review of the military medical care system required under subsection (b)(1) the following: (1) For each of the fiscal years 1993 through 1997 and over a longer range periods of 10 years and 15 years, the numbers, types, and geographic distribution of active duty and civilian personnel and fixed military treatment facilities needed to support the Armed Forces during a war or other conflict if such a war or conflict occurred during such fiscal years and each such period, respectively. (2) An analysis of adjustments to the military medical care system that may be needed to provide cost-effective care in peacetime to covered beneficiaries, including in the analysis of cost-effectiveness the following: (A) The various methods available for providing health and dental care to covered beneficiaries (including providing such care through Medicare risk contractors) that exist as alternatives to the existing methods of providing such care to covered beneficiaries under the military medical care system. (B) The full range of marginal costs associated with providing different clinical services directly in military treatment facilities and a comparison of the costs of providing such care in facilities of the uniformed services with the costs of providing such care pursuant to regional indemnity contract plans and health maintenance organization contract plans. (C) Any plans of the Secretary of Defense to increase or reduce premiums, fees, copayments, or other charges, and the likely responsiveness of beneficiaries to such changes, including the “trade-off’ factors displayed when covered beneficiaries choose between direct military care and care provided in the civilian sector. (D) Any differences in providing care between covered beneficiaries who live within 40 miles of military treatment 105 STAT. 1410facilities and covered beneficiaries who live outside such catchment areas. (3) An evaluation of the use by covered beneficiaries of in-patient and outpatient health care services, stated in terms of use per member and variations in that per member use by armed force, clinical service, and geographic areas, and a comparison of that use with utilization in civilian indemnity plans, Blue Cross and Blue Shield plans, health maintenance organizations, and with utilization guidelines prepared by the medical community, in order to— (A) identify any systematic problems in either the over-use or underuse of health care services by beneficiaries of the military medical care system or any excesses or deficiencies in the availability of health and dental care services in facilities of the uniformed services; (B) analyze the relationship between the demand for health care and the availability of military medical resources; and (C) plan new methods for influencing or managing peace-time use of health care services, including redesigned budgetary and financial incentives and programs of utilization review. (4) The costs of the present system during fiscal year 1992 and the projected costs of a reconfigured system during each of the fiscal years and periods referred to in paragraph (1). (5) An evaluation of the quality and availability of preventive health and dental care. (6) An evaluation of the adequacy of existing regulations to ensure that the existing and future availability of appropriate health care for disabled active and reserve members of the Armed Forces is adequate. (7) An assessment of the quality and availability of mental health services for members of the Armed Forces and their dependents, including a comparison of services available in various demonstration sites. (8) An assessment of the qualifications of the personnel involved in the Department of Defense review of the utilization of mental health benefits provided under the Civilian Health and Medical Program of the Uniformed Services. (9) An evaluation of the efficacy of the actions taken by the Secretary to ensure that individuals carrying out medical or financial evaluations under the system make such disclosures of personal financial matters as are necessary to ensure that financial considerations do not improperly affect such evaluations. (10) An evaluation of the adequacy of the existing appeals process and of existing procedures to ensure the protection of patient rights. (11) The optimal military and Department of Defense civilian staffing plan for the next five years to achieve the most cost-effective delivery of health care services to the beneficiary population and a strategy to achieve that goal in light of reductions in military spending and the size of the Armed Forces. (12) Any other information related to the review required by subsection (b)(1) that the Secretary determines to be appropriate. 105 STAT. 1411 (e) Additional Items of Reports.—The report required by subsection (a) shall also include the following: (1) The results of the survey conducted pursuant to subsection (c). (2) The results of the review conducted pursuant to subsection (b)(2). (3) A description of any plans of the Secretary of Defense to use any alternative methods to the existing military medical care system to ensure that suitable health and dental care is available to covered beneficiaries. (4) A proposal for purchasing health care for covered beneficiaries through private-sector managed care programs, together with a discussion of the cost-effectiveness and practicality of doing so within the military medical care system. (5) Any other information that the Secretary determines to be appropriate. (f) Definitions.—For purposes of this section: (1) The term “military medical care system” means the program of medical and dental care provided for under chapter 55 of title 10, United States Code. (2) The term “covered beneficiaries” means the beneficiaries under chapter 55 of title 10, United States Code, other than the beneficiaries under section 1074(a) of such title.