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INTRODUCTION

This JAMA Guide to Statistics and Methods describes the use of Tricare insurance claims data from the US Department of Defense to assess health care needs, utilization, and outcomes in active, retired, and disabled military service members.

Tricare (often styled TRICARE) is the insurance product owned and operated by the US Department of Defense (DoD); it covers more than 9 million beneficiaries nationwide (Box 6).1-3 Tricare claims data are maintained by the Military Health System Data Repository (MDR).1-5 Research is performed using administrative insurance claims prepared by the MDR.

BOX 6 Attributes of Tricare Claims Data

  1. Tricare claims have been used to study health care utilization, prescription drug use, provider-induced demand, and the potential impact of universal insurance to reduce disparities in surgical care.

  2. The demographic, educational, and vocational diversity of the population covered through Tricare likely renders data generalizable to the average American individual under age 65 years.

  3. Tricare data has many of the limitations inherent to administrative claims data sets.

  4. Reweighted estimating equations or multiple imputation may be used to adjust for the percentage of the population with missing data.

  5. Analyses employing Tricare data should account for the environment of care (eg, Direct vs Purchased Care) in some fashion.

USE OF THE DATA

Salient and Unique Features of the Data Set

Tricare insurance is available to active duty service members, retirees, and individuals who are separated from service with certain disabilities, as well as their dependents.1 At present, only 20% of the covered population consists of active military personnel, with the remaining 80% composed of civilians.1-5 Eligible beneficiaries can maintain Tricare coverage through age 65 years, when transition to Medicare coverage typically occurs. The diverse sociodemographic, vocational, educational, and occupational characteristics of the population insured through Tricare have been found to be representative of the general US population up to age 64 years.1,5,6 Tricare insurance is not used to cover services administered in combat zones or health care provided through the Veterans Administration (VA). Individuals with both VA benefits and Tricare may choose to receive some or all aspects of their care at VA hospitals.

How Are Data Compiled?

Tricare beneficiaries may receive care at DoD-administered health care facilities (termed direct care) or at civilian hospitals and clinics that accept Tricare (termed purchased care).1,3,5,6 Direct Care centers include 60 inpatient acute care hospitals, 385 stand-alone medical clinics, and 350 dental clinics. Irrespective of the site of service or the environment of care (eg, DoD vs civilian centers), all claims filed through Tricare (including inpatient and outpatient facility and physician fees, dental services, prescription medications, and durable medical equipment) are captured by the MDR.2,5,6 Claims are verified using standard administrative practices for the purposes of providing payment. Data for the individual subscriber are linked over time, ...

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