A New Report for First Time Examines Morbidity Burdens Among Non-Service Member Beneficiaries of the Military Health System Time

Nearly 70 percent, or about 4.7 million of the 6.8 million beneficiaries, received all of their care at outsourced care facilities, the report said. That contrasts with the 922,556 (13.6 percent) who received all of their care through military treatment facilities, and the nearly 1.2 million (17 percent) who got their care from both sources.

The report is the first to estimate the overall morbidity burdens among non-service member beneficiaries of the MHS and was published in the April issue of Medical Surveillance Monthly Report from the Armed Forces Health Surveillance Center (AFHSC) released on May 7. The surveillance period was January 1 through December 31, 2013. The surveillance population included all non-service member beneficiaries of the MHS who had at least one hospitalization or outpatient medical encounter during 2013 either through a military medical facility/provider or a civilian facility/provider (if paid for by the MHS).

In 2013, a total of 6,764,824 non-service member beneficiaries of the MHS had 83,098,152 medical encounters either in military medical facilities or paid for through the MHS (Table 1). On average, each individual who accessed care from the MHS had 12.3 medical encounters. In this population, there were more females (58 percent) than males (42 percent) and more infants, children, and adolescents (<20 years: n=1.9 million; 28.9%) and more seniors (65 years or older: n=1.8 million; 26.1%) than younger (20–44 years: n=1.4 million; 20.1%) or older (45–64 years: n=1.7 million; 24.9%) adults.

“Even though about 90 percent of non-military beneficiaries received outsourced care, about 85 percent of military service members received care in military treatment facilities,” said Air Force Major Patricia Rohrbeck, assistant director of the Epidemiology and Analysis division at AFHSC.

The report also documents that the types of morbidity and the natures of the care provided for evaluation and treatment sharply differ across age groups of beneficiaries.

For example, individuals older than 65 years of age accounted for nearly half of all medical encounters (47 percent) and a majority (60 percent) of all hospital bed days among beneficiaries not currently in military service in 2013.

In 2013, mental disorders accounted for the largest proportions of the morbidity and healthcare burdens that affected the pediatric (0-17 years) and adult (18-44 years) beneficiary age groups. Among pediatric beneficiaries, nearly 60 percent of medical encounters for mental disorders were attributable to autistic disorders, attention deficit disorders, and developmental speech/language disorders. Children affected by autistic disorders had, on average, 62.6 autism-related encounters each during the one-year surveillance period.

Among adults (18-44 years), mental disorders accounted for more medical encounters than any other major category of illnesses or injuries. However, the proportion of all encounters attributable to mental disorders was markedly less among adults (18-44 years) (14.7%) compared to pediatric (25.1%) beneficiaries. Also, the mental disorders that accounted for the largest healthcare burdens among adults (18-44 years) – mood, anxiety, and adjustment disorders – differed from those that most affected the pediatric age group.

Among older adults (aged 44–65 years), musculoskeletal diseases were the greatest contributors to morbidity and healthcare burdens; and among adults aged 65 years or older, cardiovascular diseases were the major morbidity and healthcare burdens. Of musculoskeletal diseases, back problems were the major source of healthcare burden; and of cardiovascular diseases, essential hypertension, cerebrovascular disease, and ischemic heart disease accounted for the largest healthcare burdens.

“It is no surprise that the patterns of health care among children, young adults, and senior citizens in the MHS mirror those of the general civilian population,” Major Rohrbeck said. “The types of illness and injury reflect the effects of age and gender on patterns of human health.” Click here to read entire study. The MSMR is the flagship publication for the AFHSC, featuring articles on evidence-based estimates of the incidence, distribution, impact and trends of illness and injuries among U.S. military service members and associated populations.