Introduction
TRICARE provides medical coverage in military health and private institutions for the Department of Defense, adopted in the 19 th century. The program safeguards active and retired personnel under the age of 65 and their families and covered over six million individuals by 2014 (Zelaya & Nugent, 2018). Individuals in active duty and their families do not incur yearly enrollment fees, monthly fees, or out of pocket expenses for treatment (Zelaya & Nugent, 2018). Retired service individuals and their families must pay a yearly fee of about 250 dollars but no monthly installment. Also, they incur out of pocket costs of up to 30 dollars in outpatient primary care.
Organizational Context
Statistics in the United States indicate that women bear their first children when they are about thirty-five years old or over (Stahlman & Fan, 2019). The same scenario has replicated itself in the military, where the highest birth rates between 2012-2016 were from women above thirty, having a 1% increase in those years from 10 to 11 percent. A survey conducted in 2018 showed a higher prevalence of infertility rates among women in service than the overall population (Stahlman & Fan, 2019). Almost 40% of survey respondents reported experiencing trouble getting pregnant while actively trying to. The worrying trend can be attributed to possible trauma or toxicity that servicewomen are exposed to on the job. Servicewomen also have incidences of tobacco and alcohol use that put them at greater risk of infertility compared to other women nationally (Stahlman & Fan, 2019). The number of women in military service is on a rising trajectory. Of these women, over 95% percent are of reproductive age; therefore, it is necessary to articulate the distinct reproductive needs of women in military service. Women of racial minorities are more likely to self-report on infertility compared to white women (Goossen et al., 2019). TRICARE covers medical care and procedures that could lead individuals to conceive naturally, such as laboratory tests or corrective surgery. With the increased risk of infertility cases in service women due to environmental exposure, TRICARE does not come across as a responsive partner in meeting the needs of this population.
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Assisted reproductive technologies are commonly used for infertility care in the US, and more so, in-vitro fertilization (IVF). Another common treatment is Intra-uterine Insemination (IUI), commonly explored as a first resort before invasive IVF methods. The Center for Reproductive rights reports that there are two IVF births recorded annually in the United States. As IVF and IUI usage increases, so have the out of pocket costs that patients incur to receive service. The high costs may lead women to discontinue IVF treatment after an unsuccessful round. It was found that women without insurance are three times more likely to discontinue after one unsuccessful cycle. Individuals covered by TRICARE can access reproductive care from military treatment facilities (MTFs) or civilian providers. Only six MFTs, out of the 700 in the country, offer a full range of services, including IVF, which limits care access and leads to long wait times at facilities.
The Change Required and Underlying Reasons
The change advocated for is the coverage of infertility-based procedures, namely, Invitro fertilization and intrauterine insemination. In 2016, the government made an announcement saying it understands the demands upon women in military service. Because of this, the pentagon began to cover an egg freezing program for individuals on active duty (Liu, 2017). The program was available to any service officer who put forth a request as well as those awaiting deployment. Though TRICARE would cover the cost of freezing the eggs, it does not cover IVF nor IUI. Therefore, service officers who benefitted from the egg freezing program would incur additional costs for IVF (Liu, 2017).
Psychological Effects
Infertility is a major concern given that there are a hundred in every population of 10,000 servicewomen who suffer from infertility issues. Compared to the general population, military individuals have a higher number of diagnosed infertilities. Taking a similar initiative, the government should provide assistive care for these service individuals. Infertility causes emotional and psychological distress to those affected. Some measures for positive guidance on the matter could be to investigate the cause of infertility and cover alternative conception methods if the reasons are service-related, to begin with.
Alleviate the Financial Burden
The United States Army is a volunteer-based model of providing service. Among the largest concerns of active service officers and their families are finances. Financial challenges occur despite service officers receiving more attractive compensation compared to civilians. The reasons for better compensation can be attributed to the associated job risks and costs of training. However, the spouses of individuals in military service experience career stagnation due to frequent moving, which lowers the sum of the household income compared to a civilian household (Carlson et al., 2016). Likewise, there are major differences in how civilians and military personnel make financial decisions. A study found that it is likely for military individuals to make negative financial decisions, such as incurring a huge credit card debt compared to civilian counterparts (Carlson et al., 2016). TRICARE should cover IUI and IVFs to lift off the financial burden on military families. Intra-uterine insemination is usually cheaper compared to Invitro fertilization. The average cost of IUI’s in the United States is between $300 to $1000, without insurance. On the other hand, IVF costs $12,000 on average for one cycle without including the costs of drugs. These services are costly, even though some care institutions provide discounts for IVF procedures for individuals who are covered by TRICARE.
Organizational Choice
Healthcare issues have been discussed and researched far and wide on the general population in the United States. However, much of the studies concerning the military have centered on mental health issues and compensation. The organization is appropriate for this study because of its far-reaching impact and because it is focused on reproductive health for women whose scale can be covered. In its over 30 years of history, TRICARE has not adopted changes to its function according to the evolving healthcare system. Service officers experience barriers of accessibility to infertility care (Center for Reproductive Rights, 2020). IVF coverage in the Department of Defense started in 2012, and eligible members have to fit a criterion whereby they have to be on active duty, suffered an injury or illness during the specific duty, and encountered a loss of reproductive ability due to the injury or illness. However, individuals who lost this ability on social factors are discriminated against and have no access to infertility care (Center for Reproductive Rights, 2020). It is necessary that TRICARE supports and protects the rights of service officers on making decisions about their reproductive health and address the high demand for IVF and IUI by expanding medical coverage.
References
Zelaya, C. E., & Nugent, C. N. (2018). Trends in health insurance and type among military veterans: the United States, 2000–2016. American journal of public health , 108 (3), 361-367.
Hosek, S. D., Sorbero, M. E., Martsolf, G. R., & Kandrack, R. (2016). Introducing Value-based Purchasing Into TRICARE Reform.
Carlson, M. B., Nelson, J. S., & Skimmyhorn, W. L. (2016). Military personal finance research. In Handbook of consumer finance research (pp. 251-264). Springer, Cham.
Liu, G. Y. (2017). A Call to Arms: The Department of Defense's Egg Freezing Benefit Summons Increased Reporting Regulations. Duke J. Gender L. & Pol'y , 25 , 129.
Goossen, R. P., Summers, K. M., Ryan, G. L., Mengeling, M. A., Booth, B. M., Torner, J. C., ... & Sadler, A. G. (2019). Ethnic minority status and experiences of infertility in female veterans. Journal of Women's Health , 28 (1), 63-68.
Stahlman, S., & Fan, M. (2019). Female infertility, active component service women, US Armed Forces, 2013-2018. MSMR , 26 (6), 20-27.
Center for Reproductive Rights. (2020). Access to IVF for Servicemembers and Veterans [PDF]. Center for Reproductive Rights.
