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#### TRICARE CHILD BENEFICIARY REPORTS HELP INDEX

Glossary
About the Health Care Survey of DoD Beneficiaries
Regions
Enrollment Groups
Ratings and Composite Scores
How Scores are Calculated
How Scores are Adjusted
Color Guide
Survey Questions
Benchmarks
Trends
Standard and Printer-Friendly Versions
For More Information

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### Glossary

HCSDB — Health Care Survey of DoD Beneficiaries
MHS — military health system
NCBD — 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

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### About the Health Care Survey of DoD Beneficiaries

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 is sent each year to parents of children who were eligible for military health care in 2004 and 2005. 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.

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### Regions

The TRICARE CONUS population can be divided into three geographic regions. The areas are:

- North

- South

- West

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### Enrollment Groups

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

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### Ratings and Composite Scores

The findings in these reports are based on parents' responses to the 2004, 2005, and 2006 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.

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### How Scores are Calculated

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 region and for CONUS MHS, a score is calculated for each question in a composite. The scores then are averaged together.

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### How Scores are Adjusted

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.

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### Color Guide

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.

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### Survey Questions

Getting Needed Care — Composite

> Since you joined your health plan, how much of a problem, if any, was it to get a personal doctor or nurse 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 see 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 the care, tests or treatment you or your 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 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, not counting times you needed health care right away, how often did your child get an appointment for 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, injury, or condition, how often did your child get care as soon as you wanted?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often was your child taken to the exam room within 15 minutes of his or her appointment?

> - 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

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

Customer Service — Composite

> In the last 12 months, did you look for any information about how your child's health plan works in written material or on the internet?

> In the last 12 months, how much of a problem, if any, was it to find or understand this information?

> - 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

Involve Parents — Composite

> In the last 12 months, how often did your child's doctors or health providers make it easy for you to discuss your questions or concerns?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often did you get the specific information you needed from your child's doctors or other health providers?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often did you have your questions answered by your child's doctors or other health providers?

> - Never
> - Sometimes
> - Usually
> - Always

> When decisions were made in the last 12 months, how often did your child's doctors or health providers involve you as much as you wanted?

> - Never
> - Sometimes
> - Usually
> - Always

Special Needs — Composite

> In the last 12 months, how much of a problem, if any, was it to get special medical equipment for your child?

> - 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 special therapy for your child?

> - 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 this treatment or counseling for your child?

> - A big problem
> - A small problem
> - Not a problem

Global Parent Ratings

> Using any number from 0 to 10 where 0 is the worst personal doctor or nurse possible and 10 is the best personal doctor or nurse possible, what number would you use to 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

> Using any number from 0 to 10 where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your child's health care in the last 12 months?

> - 0 Worst health care possible
> - 1
> - 2
> - 3
> - 4
> - 5
> - 6
> - 7
> - 8
> - 9
> - 10 Best health care possible

> Using any number from 0 to 10 where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate your child's specialist?

> - 0 Worst specialist possible
> - 1
> - 2
> - 3
> - 4
> - 5
> - 6
> - 7
> - 8
> - 9
> - 10 Best specialist possible

> Using any number from 0 to 10 where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to 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

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### Benchmarks

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 2004. 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.

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### Trends

Trends are calculated as the difference between the scores for 2004 and 2006. 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.

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### Standard and Printer-Friendly Versions

TRICARE Beneficiary Reports are available in two versions: standard and printer-friendly. On your computer screen, the standard version is usually the easier of the two versions to read. You can make the table rows scroll past while the table headings stay in place. If the standard version does not work well on your screen, or if you prefer it, the printer-friendly version presents both the header and rows as a single sheet. If you would like to print out a page, use the printer-friendly version. If you would like to use a table at your desk top, each page can be downloaded in an Excel spreadsheet by clicking on the link found at the bottom of the page.

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### For More Information

The questions, survey methods, and calculations are described in detail in the 2006 Health Care Survey of DoD Beneficiaries: Child Technical Manual.

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