National Oceanic and Atmospheric Administration—and the National Guard and Reserves. It is the contemporary embodiment of a commitment to provide care for the country’s defense and fighting force that extends back to 1775 and has evolved to extend services to the larger military family (DOD, 2009). TRICARE had its origins in demonstration projects and a reform initiative implemented in the 1980s in the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).2 Its integrated system grew out of what had been disparate programs that provided care to active-duty personnel via military health facilities and to their dependents, retirees,3 and other eligible persons via a network of military and civilian providers. The program’s services combine the health-care resources of military treatment facilities (MTFs)—referred to as the direct-care component—with networks of civilian health-care professionals, medical facilities, and suppliers—the purchased-care component.

TRICARE operates as a single-payer system and covers most inpatient and outpatient medical care that is deemed necessary by a medical professional, including emergency and urgent care, medical and surgical procedures received on an inpatient basis and an outpatient basis, home health care, hospice care, clinical preventive services, maternity care, pharmacy services, and behavioral health care services (TRICARE, 2009b). The TRICARE program is managed by the TRICARE Management Activity (TMA) under the DOD assistant secretary of defense for health affairs. It is organized into six geographic health-service regions. The three regions in the United States are TRICARE North, TRICARE South, and TRICARE West; and the regions abroad are TRICARE Europe, TRICARE Latin America and Canada, and TRICARE Pacific. Each region is responsible for overseeing the administration and management of TRICARE health services, funding regional initiatives to improve the delivery of health-care services,

2

CHAMPUS is still referred to in some regulatory and policy documents that address TRICARE operations.

3

The US Office of Personnel Management offers the following somewhat circular definition of a military retiree: “any member or former member of the uniformed services who is entitled, under statute, to retired, retirement, or retainer pay on account of service as a member, or who receives military retired or retainer pay” (OPM, 2009). Eligibility for retiree status is usually determined by length of service (typically, 20 years or more), although there are other circumstances in which a service member may qualify. Military retirees are a subset of military veterans.



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