Glossary
About the Health Care Survey of DoD Beneficiaries
Super Regions
Enrollment Groups
Primary Care Managers
Ratings and Composite Scores
How Scores are Calculated
How Scores are Adjusted
Color Guide
Survey Questions
Benchmarks
Trends
For More Information
HCSDB Health Care Survey of DoD Beneficiaries
MHS military health system
PCM primary care manager
NCDB National CAHPS Benchmarking Database
MTF Military Treatment Facility
CONUS MHS MHS in Continental United States, plus Hawaii and Alaska
CAHPS Consumer Assessment of Health Plans Survey
Benchmark A goal or standard of comparison
Composite A score based on a combination of items
The Child Health Care Survey of DoD Beneficiaries (HCSDB) is a congressionally mandated annual survey of parents in the military. It is designed to measure parents' satisfaction with their child's health care. The survey was sent to parents of children who were eligible for military health care in 2000, 2001, and 2002. The questionnaire closely resembles the Consumer Assessment of Health Plans Survey (CAHPS) which is often used to monitor the civilian population's experience in commercial health plans or in the Medicaid and Medicare programs. There are also unique survey questions that address special MHS concerns.
The TRICARE population can be divided into three "super" geographic regions which reflect the relative maturity of the TRICARE Prime health plan in each regional group. The areas are referred to as:
NEW regions (1, 2, and 5) - Prime was implemented most recently
MATURE regions (6, 9-12, and Alaska) - Prime has been in place for an extended period
All other regions (3, 4, and 7/8)
Click here for a map of TRICARE regions
Enrollment groups classify beneficiaries according to their relationship to TRICARE Prime, the military's managed care plan, as follows:
TRICARE Prime enrollees, including two subgroups:
TRICARE Prime enrollees with a military primary care manager (PCM)
TRICARE Prime enrollees with a civilian PCM
TRICARE beneficiaries not enrolled in Prime
The primary care manager is the provider (or team of providers) that enrollees in TRICARE Prime see first for their health care needs. The primary care manager :
Provides and/or coordinates care;
Maintains health records;
Makes referrals to specialists. (To be covered, specialty care must be arranged and approved by a primary care manager.)
The findings in these reports are based on parents' responses to the 2002 Child Health Care Survey of DoD Beneficiaries. All scores have been converted to a 0 to 100 scale. There are two types of scores:
Ratings - The survey asks parents to rate various aspects of their children's health care on a scale of 0 to 10, where 0 is the worst and 10 is the best. Ratings are reported as the percentage of parents rating an aspect of care 8 or higher.
Composite Scores - The composite scores average responses from several different but related questions.
To view parents' responses to the component questions in a composite, click on the composite column heading in the report.
Composite scores for ease of access, how well doctors communicate, and customer service are all calculated the same way. The possible responses to each question are ordered from the worst to the best. A question's score is the percentage of responses falling in the best category ("Getting Needed Care" and "Customer Service") or best two categories (all others). For each super region and for CONUS MHS, a score is calculated for each question in a composite. The scores then are averaged together.
The CAHPS benchmarks are adjusted to reflect any differences, such as child's age, parent's age, parent's education, and child's health status, in the benchmark population compared with MHS beneficiaries. The precision of the MHS scores is calculated using the residuals from the regressions used to adjust the scores and accounting for the survey's complex sample design. Then a t-test is used to measure the probability that the difference between a score and a benchmark occurred by chance. If the probability is less than 5%, the difference is significant.
The colors of the scores on each page show whether a score differs significantly from its civilian benchmark. A difference is significant if it is large enough that it is unlikely to occur by chance (i.e., the probability that it occurs by chance is less than 5 percent). If a score is significantly higher than the benchmark, it is green and bold. If it is significantly lower than the benchmark, it is red and italicized. Scores that are not significantly different from the benchmark are blue.
Getting Needed Care Composite
With the choices your child's health plan gave you, how much of a problem, if any, was it to get a personal doctor or nurse for your child you are happy with?
- A big problem
- A small problem
- Not a problem
In the last 12 months, how much of a problem, if any, was it to get a referral to a specialist that your child needed to see?
- A big problem
- A small problem
- Not a problem
In the last 12 months, how much of a problem, if any, was it to get care for your child that you or a doctor believed necessary?
- A big problem
- A small problem
- Not a problem
In the last 12 months, how much of a problem, if any, were delays in your child's health care while you waited for approval from your child's health plan?
- A big problem
- A small problem
- Not a problem
Getting Care Quickly Composite
In the last 12 months, when you called during regular office hours, how often did you get the help or advice you needed for your child?
- Never
- Sometimes
- Usually
- Always
In the last 12 months, how often did your child get an appointment for regular or routine health care as soon as you wanted?
- Never
- Sometimes
- Usually
- Always
In the last 12 months, when your child needed care right away for an illness or injury, how often did your child get care as soon as you wanted?
- Never
- Sometimes
- Usually
- Always
In the last 12 months, how often did your child wait in the doctor's office or clinic more than 15 minutes past the appointment time to see the person your child went to see?
- Never
- Sometimes
- Usually
- Always
How Well Doctors Communicate Composite
In the last 12 months, how often did your child's doctors or other health providers listen carefully to you?
- Never
- Sometimes
- Usually
- Always
In the last 12 months, how often did your child's doctors or other health providers explain things in a way you could understand?
- Never
- Sometimes
- Usually
- Always
In the last 12 months, how often did your child's doctors or other health providers show respect for what you had to say?
- Never
- Sometimes
- Usually
- Always
In the last 12 months, how often did doctors or other health providers explain things in a way your child could understand?
- Never
- Sometimes
- Usually
- Always
In the last 12 months, how often did doctors or other health providers spend enough time with your child?
- Never
- Sometimes
- Usually
- Always
In the last 12 months, how often did your child's health plan handle your child's claims in a reasonable time?
- Never
- Sometimes
- Usually
- Always
In the last 12 months, how often did your child's health plan handle your child's claims correctly?
- Never
- Sometimes
- Usually
- Always
Courteous and Helpful Office Staff Composite
In the last 12 months, how often did office staff at your child's doctor's office or clinic treat you and your child with courtesy and respect?
- Never
- Sometimes
- Usually
- Always
In the last 12 months, how often were office staff at your child's doctor's office or clinic as helpful as you thought they should be?
- Never
- Sometimes
- Usually
- Always
In the last 12 months, how much of a problem, if any, was it to find or understand information in the written materials?
- A big problem
- A small problem
- Not a problem
In the last 12 months, how much of a problem, if any, was it to get the help you needed when you called your child's health plan's customer service?
- A big problem
- A small problem
- Not a problem
In the last 12 months, how much of a problem, if any, did you have with paperwork for your child's health plan?
- A big problem
- A small problem
- Not a problem
Primary Care Manager Composite
For members of TRICARE Prime, the primary point of contact regarding your child's health is called a primary care manager, or PCM. This may be the same person as your child's personal doctor or nurse. Does your child have a TRICARE primary care manager?
- Yes
- No
Do you know the name of your child's TRICARE primary care manager?
- Yes
- No
In the last 12 months, how much of a problem was it for your child to see his or her TRICARE primary care manager?
- A big problem
- A small problem
- Not a problem
Use any number from 0 to 10 where 0 is the worst personal doctor or nurse and 10 is the best personal doctor or nurse possible. How would you rate your child's personal doctor or nurse?
- 0 Worst personal doctor or nurse possible
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10 Best personal doctor or nurse possible
Use any number from 0 to 10 where 0 is the worst health care possible and 10 is the best health care possible. How would you rate all your child's health care?
- 0 Worst health care possible
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10 Best health care possible
Use any number from 0 to 10 where 0 is the worst specialist possible and 10 is the best specialist possible. How would you rate your child's specialist?
- 0 Worst specialist possible
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10 Best specialist possible
Use any number from 0 to 10 where 0 is the worst health plan possible and 10 is the best health plan possible. How would you rate your child's health plan?
- 0 Worst health plan possible
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10 Best health plan possible
Most of the questions in the Child HCSDB are identical to questions from the Consumer Assessment of Health Plans Survey (CAHPS). Because many health plans that serve the civilian population use that survey to assess the experience of their enrollees, the CAHPS results can be used as benchmarks for comparison with care delivered in the MHS. Benchmarks for the composites and numeric ratings are taken from CAHPS, and the questions in the composites come from the National CAHPS Benchmarking Database (NCBD) for 1999. The NCBD collects responses to the survey from a national sample of health plans that serve the civilian population. The benchmarks are adjusted to correspond to the demographic characteristics of the MHS population.
Trends are calculated as the difference between the scores for 2000 and 2002. For significance tests, the change in scores is compared to the change in the benchmark due to changes in parent's age and child's health status.
The questions, survey methods, and calculations are described in detail in the 2002 Health Care Survey of DoD Beneficiaries: Child Technical Manual.