Hosek Susan D, Sorbero Melony E, Martsolf Grant, Kandrack Ryan
Rand Health Q. 2017 Jan 13;6(2):9. eCollection 2017 Jan.
TRICARE, the health benefits program created for beneficiaries of the U.S. Department of Defense, covers health care provided in military treatment facilities and by civilian providers. Congress is now considering how to update TRICARE, which was first developed in the 1980s drawing on managed care concepts from civilian health plans. This article places TRICARE's current managed care strategy in historical context and describes recent innovations by private insurers and Medicare intended to enhance the value---cost and quality---of the care they purchase for their members. With this movement toward value-based purchasing as background, the authors evaluate two existing proposals for reform and describe an alternative approach that blends the existing proposals.
“特里卡尔”（TRICARE）是为美国国防部受益人设立的医疗福利项目，涵盖军事治疗机构和民用医疗服务提供商提供的医疗保健服务。国会目前正在考虑如何更新“特里卡尔”项目，该项目最初于20世纪80年代借鉴民用健康计划中的管理式医疗概念而制定。本文将“特里卡尔”目前的管理式医疗策略置于历史背景中，并描述了私人保险公司和医疗保险机构近期为提高其为会员购买的医疗服务的价值（成本和质量）而进行的创新。以这种向基于价值的采购的转变为背景，作者评估了两项现有的改革提案，并描述了一种融合现有提案的替代方法。
