Expectations of Military Healthcare: An Inductive Analysis

The purpose of this study was to better understand patient satisfaction among Army beneficiaries by examining consumer and health care personnel experiences with and expectations of the Military Health System (MHS). A cross-sectional, interpretive design was used. Husserlian descriptive phenomenology, as advocated by Colaizzi, guided the analysis. Data was gathered through 22 focus groups and 14 interviews involving a total of 111 participants. Regardless of geographic region (e.g. east coast or west coast), beneficiary status (e.g., active duty, retiree, family member), role (e.g., consumer or health care personnel), or delivery option (a combination of TRICARE insurance options and site of care(e.g. Military Treatment Facility or civilian provider on the network) experiences within and expectations of the MHS were common. The experiences are summarized as: (a) TRICARE can be an obstacle to getting care and (b) health care personnel are caught between what gets resourced and competing demands (e.g., military commanders, beneficiaries, TRICARE insurance rules). The expectations are summarized as: (a) treat beneficiaries like they matter, (b) make the MHS a benefit, not a barrier, and (c) resource and structure the MHS so providers have what they need. The four overarching themes were: (a) military unique aspects of healthcare, (b) care barriers, (c) TRICARE as an insurance program, and (d) customer relations. Two serendipitous discoveries were interpreted from the data. The first, "My Care", consists of a constellation of features participants considered desirable in health care. The second, "Soldier Care", pertains to the realities of how soldiers access health care at the unit level which remains outside the TRICARE program. These findings can be used by MHS staff at all levels, from direct care personnel to policy makers and executives, to change care delivery by narrowing the gap between what Army beneficiaries experience and what they expect.