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TRICARE-covered children have similar access to health care as children with other types of insurance, but there are some differences

• Caregivers of TRICARE-covered children were more likely to report having coverage for mental and behavioral health needs and less likely to report problems paying for health care.
• They were less likely to have one person they considered their child's personal provider, were more likely to need referrals, and reported greater difficulty getting referrals.
• Among TRICARE beneficiaries, active-duty families were more likely to have a usual source of care and less likely to have problems paying for care. Access to care also varied slightly across different TRICARE plans.

TRICARE-covered children with complex health needs may face particular challenges getting care and services

• Among TRICARE beneficiaries, caregivers of children with special health care needs reported more difficulty getting referrals for specialty care, were more likely to report not getting needed care, had more frustration getting care, and had a greater desire for care coordination help than caregivers of children without special health care needs.

Relocations can be burdensome for military families and can affect children's access to health care

• TRICARE-covered children experience more address changes in their lives than children with other types of insurance.
• Disruptions caused by military relocations may be particularly detrimental for children with special health care needs.
• Within TRICARE, children who moved frequently reported significantly worse access than those who had never moved over a child's life, including more desire for increased care coordination.

TRICARE, the U.S. Department of Defense insurance program for eligible service members and their dependents, provides health care coverage to nearly 2 million children under the age of 18. Survey data and prior evaluations indicate that TRICARE-covered children face challenges in accessing pediatric health care, with the greatest challenges among children who have experienced frequent relocations and children with special health care needs. However, TRICARE has not measured pediatric patient experiences in accessing care since 2010. To fill this gap, RAND researchers analyzed national survey data on the experiences of caregivers of TRICARE-covered children and children with commercial insurance, public insurance, and no insurance to identify differences in access to pediatric care, necessary referrals, care coordination support, ability to pay medical bills, and other factors. Additional analyses highlight variations between children with different TRICARE plans, between children who have changed addresses more and less frequently, and between children with special health care needs and those without. The findings should help inform efforts to increase access to care for children across the Military Health System, as well as improvements to programs designed to support military families during relocations and those with children who have special health care needs.

• Chapter One

  Introduction

• Chapter Two

  Study Objective and Overview of Methods

• Chapter Three

  Evaluation of Access to Care Among TRICARE-Covered Children

• Chapter Four

  Children with Special Health Care Needs

• Chapter Five

  Impact of Relocations on Access to Care for TRICARE-Covered Children

• Chapter Six

  Summary and Recommendations

• Appendix

  Detailed Analytic Results