Families With TRICARE: The Authors Reply

Abstract

Letters Health AffairsVol. 38, No. 11: Household Costs, Food & More Families With TRICARE: The Authors ReplyDavid M. Rubin, Roopa Seshadri, and Karen Ruedisueli AffiliationsChildren’s Hospital of Philadelphia Philadelphia, PennsylvaniaNational Military Family Association Arlington, VirginiaPUBLISHED:November 2019Free Accesshttps://doi.org/10.1377/hlthaff.2019.01320AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSTRICAREAccess to careChildren's healthMilitary Health SystemQuality of careSpecial health care needsBehavioral health careNo article is immune to uncertainty in its inferences, and we agree with Terry Adirim and coauthors that our report on the health care experience of military dependents has limitations often found in panel survey studies (Aug 2019). However, the authors’ letter critiquing our study, the first to compare health care experiences between military and civilian families, overstates these limitations. The net result of any misclassification of military families into Medicaid and privately insured comparison groups would have biased our results to the null, adding significance to our observed findings.As with many panel surveys, our samples—military and civilian—were small but representative, and sample weights supplied by the Medical Expenditure Panel Survey (MEPS) allowed for generalization. To discount that sampling scheme would be tantamount to discounting any study using MEPS data. Furthermore, the higher prevalence of behavioral or special health care needs was not derived from billing claims for services received but was parent reported and consistent with the robust literature on the impact of stress on child health. While the Consumer Assessment of Healthcare Providers and Systems outcome measures are subjective, they are widely used for monitoring and evaluation by public and commercial insurers.Two authors of this study served on the Pentagon’s Military Family Readiness Council. The many letters that council received from families reporting difficulty accessing services for medically complex children or those with behavioral health needs reinforce the observed results. We highlighted that TRICARE families report high satisfaction with basic services and that the frequent separations, deployments, combat stress, and relocations experienced by military families can affect children’s health and access to services. Instead of dismissing the research by challenging the data source, we encourage TRICARE leaders to continue to simplify mechanisms for families to access needed services, particularly when those services are remote or off base. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 4 November 2019 Information© 2019 Project HOPE—The People-to-People Health Foundation, Inc.PDF downloadRelated articlesFamilies Covered By TRICARE04 Nov 2019Health Affairs