A Government Accountability Office (GAO) review has found that members of the U.S. Coast Guard may face challenges accessing health care.
In support of its missions, the Coast Guard is tasked with providing health care to its active duty personnel and ensuring the availability of health care for their dependents. Coast Guard personnel have access to limited outpatient care at Coast Guard clinics. These personnel and their dependents may also obtain medical care and dental care from military facilities and civilian providers through TRICARE – the Department of Defense’s health plan, administered by the Defense Health Agency (DHA). As of October 2022, approximately 37,000 Coast Guard active duty personnel and about 51,000 Coast Guard dependents were enrolled in TRICARE. In fiscal year 2022, Coast Guard reported spending about $360 million for TRICARE medical and dental care.
GAO’s review found that the location of Coast Guard units may contribute to challenges accessing medical and dental care through TRICARE. For instance, Coast Guard active duty personnel and their dependents are more than twice as likely as the personnel and dependents from the other military services to be enrolled in TRICARE Prime Remote, which means they are stationed in an area that is more than 50 miles away from a military medical treatment facility.
Almost 40 percent of Coast Guard clinics (17 of 43 clinics) are located in medically underserved areas, which indicate a shortage of primary care services. Additionally, 25 percent (11 of 43 clinics) are located in areas with at least one type of health provider shortage (primary care, mental health, or dental).
GAO found that the Coast Guard conducts ad hoc monitoring of its beneficiaries’ access to TRICARE, but it does not routinely analyze data from DHA and its contractors to monitor access. No formal agreement exists between the Coast Guard and DHA to facilitate the sharing of data for care provided at DHA medical facilities.
During the course of its review, GAO analyzed DHA and contractor data on Coast Guard beneficiaries’ access to care through TRICARE, and found that their access to primary and dental care generally met DHA’s access standards. However, access to specialty care varied by source and type of care. Specifically, beneficiaries accessed routine specialty care from DHA medical facilities within its standard of 28 days, but access to such care from civilian providers sometimes took longer. For example, the average days to care for obstetrics and gynecology services ranged from 27 to 40 days, and the average for dermatology ranged from 31 to 41 days. Similarly, Coast Guard beneficiaries’ accessed mental health care at DHA medical facilities within 28 days, but it took on average up to 41 days to be seen by a civilian psychiatrist for routine care. When referred for urgent psychiatric care, where care is expected to be received within 3 days, average days to care ranged between 18 and 32 days. TRICARE contractors told GAO access may exceed standards for reasons such as provider availability and beneficiary preference.
In February 2022, GAO reported that Coast Guard lacked standards to outline the number and types of health care staff it needs. In response, Coast Guard officials told GAO that there were difficulties in maintaining already burdened clinic operations when health care staff are deployed, which can result in clinics deferring services. Coast Guard initiated a manpower requirements assessment for its clinics as a result of GAO’s findings but, as of December 2022, had not implemented this.
During the latest review, Coast Guard health officials and officials from six selected clinics cited staffing shortages as an access-to-care challenge for active duty personnel seeking care at Coast Guard clinics. Specifically, clinic officials reported difficulty recruiting and retaining U.S. Public Health Service (USPHS) providers, who typically serve as the medical and dental providers in Coast Guard clinics. They also reported insufficient numbers of Coast Guard health services technicians, who provide clinical and administrative support, to meet the clinics’ needs.
GAO is making seven new recommendations, including that the Coast Guard and DHA agree to share access data and that the Coast Guard monitor access to TRICARE for Coast Guard beneficiaries. The Department of Homeland Security concurred with the recommendations and stated actions to meet them including updating Coast Guard’s informal exit interview process to include a standardized questionnaire for each USPHS officer leaving the service.
