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Post-Injury General Medical Care Usage for Military Health System Beneficiaries Living in United States Primary Care
Camille Q Vu1, Sarah Prabhakar2,3, Ian S Sorensen2,3
1Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD 20814, United States.
Introduction:
Limited healthcare access can adversely affect military readiness and the health of active duty service members (ADSM) and their families, particularly following serious injury. Approximately half of U.S. military installations are overseas, or in federally designated primary care (PC) Health Professional Shortage Areas, or "PC deserts," characterized by limited provider availability and longer distances to care, which may impact post-injury care. The study objective was to assess the impact of living in a U.S. PC desert or overseas compared to a U.S. non-desert on the rate of general medical (GM) non-surgical, non-mental health care encounters during the year following a serious injury among ADSM, spouses, and children.
Materials And Methods:
A retrospective cohort study of Military Health System (MHS) data from FY 2005-2016 identified seriously injured ADSM, spouses, and children using ICD-9 codes for concussion, fractures, post-traumatic stress disorder, blindness, burns, shrapnel, and other traumatic injuries. Negative binomial regression estimated post-injury GM encounter rates comparing beneficiaries assigned to installations in PC deserts or overseas with those in U.S. non-desert areas, adjusting for age, sex, ADSM race, and rank.
Results:
Among 545,611 injured beneficiaries (301,846 ADSM, 77,813 spouses, 75,952 children), residence in PC deserts was associated with increased outpatient civilian care and decreased outpatient military treatment facility (MTF) care. In PC deserts, inpatient care was decreased for spouses and children but increased for ADSM compared to U.S. non-deserts. Overseas outpatient care was decreased for all beneficiary categories, as was inpatient care for dependents, although inpatient care for ADSM was increased overseas. In PC deserts, civilian care was generally increased, whereas overseas, care at military facilities was increased.
Conclusions:
These findings highlight geographic disparities in healthcare utilization among MHS beneficiaries and underscore the importance of considering location-based access challenges in military medical resource planning and policy.
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