ONCOLOGY SERVICES - THE DEPARTMENT-OF-DEFENSE PERSPECTIVE

The Department of Defense (DoD) military health system has responsibil ity for providing medical care for more than 8 million beneficiaries. This article discusses initiatives related to both the providing and p urchasing of oncology services. A description of health care coverage under TRICARE, the Department's managed care program, which utilizes m ilitary treatment facilities and civilian health care providers, is pr ovided. Participation in clinical trials by the DoD beneficiaries, onc ology services in military treatment facilities, quality management pr ograms, cancer research, and the development of new technologies to en hance early cancer detection are presented. Access to research trials and new technologies is necessary for a comprehensive approach to canc er care. Clinical trials have been the vehicle by which the oncology c ommunity developed most of its formal clinical evidence for the effica cy of various treatment approaches. The Department participates in cli nical trials through cooperative group membership or affiliation. Thro ugh an interagency agreement with the National Cancer Institute, DoD b eneficiaries have available the option of participating in NCI-sponsor ed clinical trials through the direct military care system or through civilian care with reimbursement for approved protocols nationwide. Th e DoD has been actively involved in breast cancer research since 1992 and prostate and ovarian cancer research since 1997. The goals of the cancer research programs are to expedite and facilitate breakthroughs in research, support innovative, and exploratory ideas with a vision t o foster new directions, address neglected issues, and bring new inves tigators into the research arena. The program incorporates the consume r perspective by involving consumers in the decision-making process. T he DoD health care system trains experts in the management of cancer p atients and provides a multidisciplinary approach to care through the direct military health care system or through network providers as par t of the TRICARE system. Although cost containment is key, the deliver y of high quality health care that is easily accessible is a primary g oal of the military health system. Provision of a comprehensive benefi ts package that includes a spectrum of care and employing outcomes mea surements to evaluate care that is appropriate for the patient's disea se is essential. (C) 1998 American Cancer Society.