European Stars and Stripes (Newspaper) - June 26, 1990, Darmstadt, Hesse                                To your health booked up at the clinic continued from Page 13 in military hospitals and clinics. Quot that excess demand Means that everybody Waits too Long Quot he said. Simply stated the problem of Access to care is caused by a significant shortage of doctors nurses and support personnel said maj. Gen. Richard t. Travis commander of the army a 7th medical come in Heidelberg West Germany. There Are various reasons for the shortages including the military s inability to recruit and retain enough physicians and nurses and the Way the number of health professionals is allowed to the services by the department of defense. A 1988 report of the Navy medical Blue ribbon panel found that Navy Medicine has been increasingly unable to provide care in the . And overseas facilities because of these shortages. Shortages mean that medical services available in the United states Are simply not offered overseas or May take months to obtain depending on the Hospital or clinic. Treatment for infertility for example is usually limited to Active duty service members. Cosmetic surgery is available Only if it is medically necessary. Many army hospitals do not perform circumcisions. Service members and civilians May wait months for vasectomies or tubal ligation. Appointments for Eye or ear nose and Throat care Are scarce. Dental care not considered a Benefit for family members is available in military dental clinics but the Waits can be Long and frustrating for treatment of any dental problem other than an emergency. In the five outlying clinics run by the Lan Stuhl army regional medical Center doctors have Little time to practice preventive Medicine such As Well baby appointments and Pap tests or to care for chronic health problems said or. Col Andre Boissevain chief of ambulatory patient care for the Hospital. Obtaining Well baby appointments is also a problem at the Wiesbaden Hospital which is staffed with an emphasis on specially care such As orthopaedics rather than primary care. A Lack of paediatricians Means the decision must be made As to a who needs to be seen the person who is acutely sick or the Well baby who Isnit sick Quot said Hospital commander or. Col Robert Gilmore. Patients who cannot get appointments at a clinic or Hospital often show up at the emergency room reducing the efficiency of emergency care. Quot people perceive the emergency room As a place they can go whenever they want Quot Boissevain said. Often they do not know where else to go especially on a weekend said Blanck adding that the majority of patients seen in the Frankfurt emergency room Are not suffering from life threatening problems. The alternative to a military facility is a local doctor. This is easier to do in England or Germany and the Netherlands where medical care is excellent and Many doctors speak English. Quot what has happened and continues to happen throughout military Medicine is that people triage themselves out of our system by their inability to wait any longer Quot Blanck said. In Mediterranean countries it can be More difficult finding competent care or a doctor who Speaks English. Pregnant women in More Remote locations of Turkey and Greece travel routinely to military hospitals in West Germany to deliver their babies. Patients living in Mediterranean countries who require routine care in specialities such As dermatology or orthopaedics Are regularly flown to the air Force Hospital in Wiesbaden Gilmore said. A patient can be away from his family or Job for As Many As six Days simply for a routine appointment. The frustration of obtaining medical appointments is aggravated by limited phone lines that require patients to Call Over and Over until they finally reach the appointment desk. At the Frankfurt Hospital the method for obtaining appointments in specially clinics has been changed so patients do not need to phone the Hospital. Instead written requests Are submitted now. These Are logged through Central appointments and prioritized according a amps l Emmett Lewis or. Or. Col Robert Gilmore commander of air Force Hospital in Wiesbaden West Germany. To category of patient medical urgency and the capability of the Hospital to handle the problem. Patients receive a letter either giving them an appointment within six weeks or telling them they must wait longer than six weeks. They Are also told they have the option of talking to a health benefits advisor who can give them a list of German physicians. Quot the whole thrust is to plan these things and be honest with people and to Tell them what we can or can to do a Blanck said. The department of defense is trying to improve the Access to care problem on a National level through intensified recruiting of nurses and doctors More enticing pay incentives and additional funding for medical personnel. For example Pentagon officials recently sent to Congress a proposal that would boost Bonus pay significantly for military doctors who sign up for multiyear service contracts. Bonuses Are one Way the military tries to compete for doctors with the civilian world. The air Force in Europe will receive 95 additional support personnel this year and 196 additional health care personnel ranging from technicians to doctors in 1991 and 1992, says col. . Jacobson jr., Deputy for health services management at Safe he. To help with the annual summer shortage More than 130 army Reserve physicians Are coming to Europe to augment staffing in hospitals and clinics Travis said. Each doctor will be Here for two weeks to one month. The summer shortage is a result of Many physicians returning to the states to begin advanced medical education programs most of which Start in the summer months. Locally hospitals and clinics Are trying to improve appointment systems and develop programs to reduce Waits in clinics and emergency rooms. The Wiesbaden Hospital is experimenting with flying specially doctors to service members and their families in Mediterranean countries rather than flying patients to Germany. Free emergency care is available at specified German hospitals for military family members when american clinics Are closed. Called the european come demonstration project it is functioning in 27 army and four air Force communities. Army and air Force hospitals can contract civilian physicians to treat beneficiaries of the civilian health and medical program of the uniformed services champs. Eight hospitals or clinics Are part of this partnership program. However these efforts Are limited in scope and cannot shorten the Long Waits or increase limited services overnight. Withdrawal of troops from Europe May improve the situation sooner than anything else. The Gao recommended that fewer medical personnel be withdrawn in proportion to other types of personnel leaving More medical services behind to care for fewer people. Quot i see that As probably the most logical recommendation i have Ever read Quot Gilmore said. Quot its an unprecedented Opportunity for us to be Able to provide the level of care that people expect and  sounding Board for patients by Janet do Agostino medical writer the Soldier had a question for Cristine Crichlow Why  he pick up the results of his wife a pregnancy test Crichlow patient representative at the Frankfurt army regional medical Center explained to the Soldier that the lab results could not be released a even to him a because of patient confidentiality. He would have to return with written consent from his wife or have his wife pick up the results. As patient representative Crichlow tries to resolve complaints searches out information educates patients and answers questions. A i can find an answer for just about everything but whether its the answer you re looking for is a different Story Quot said Crichlow. Quot if nothing else i like people to know they at least have a sounding  Carol Hilt patient representative at the Lan Stuhl army regional medical Center is often asked Why it is so difficult for family members retirees and government civilians to Book an appointment or to obtain certain medical sen ices. A a it a the most frustrating part of being a patient Quot said Hilt who explains to family members that Active duty service members have priority in military hospitals overseas which Are often Short of doctors nurses and other personnel. A part of my Job is to Tell them the truth to Tell them the reality and to Tell them their  Crichlow and Hilt know Well the Workings of the army a two largest hospitals in Europe and which person or office to go to to seek a Resolution to a patients complaint or question. This can mean talking to doctors nurses technicians or office workers whoever might be Able to assist the patient Hilt explains. Crichlow and Hilt each Deal with 300 to 500 people a month. Sometimes the requests can be taken care of by the end of the Day and other assists require More time and research. The questions they hear Are varied in a having a problem with my Bill can you help can i get medical care at a German Hospital How can i Trace my medical champs eases the pain by Janet do Agostino medical writer Lisa Sanders chose to deliver her baby in a German Hospital rather than in a military Media facility. She made that decision in order to avoid Long Waits for obstetrical care and because she did not want to see a different doctor or midwife at every appointment. Cyndi Kruedelbach prefers going to a German paediatrician for her daughter rather than to the army clinic in Darmstadt West Germany. It Means she has to pay 20 percent of the medical Bill but she feels the Benefit of seeing the same physician at each visit is Worth the Money. Like Sanders and Kruedelbach both of whom Are married to army service members stationed in Darmstadt More and More military family members Are sitting in nonmilitary waiting rooms in Europe either by Choice or by necessity. They Are there in order to avoid Long Waits or to receive medical care that is unavailable through the militia medical system. The number of insurance claims from family members and retirees using the Pentagon a civilian health insurance program is rising every year while the number of beneficiaries overseas remains fairly stable said it. Col. Frank Berlingis director of the civilian health and medical program of the uniformed services champs office in Heidelberg West Germany. Language barriers and cultural differences that at first May seem intimidating apparently Are not insurmountable. Quot i think our beneficiary Here in Europe is getting comfortable with the european system Quot said berm i the stars and stripes Quot they Are finding out it is not really As Tough to make that outpatient visit to a German facility As they might have  the Cost sharing insurance program will cover More than $34 million in health care for family members and retirees living overseas in 1990. In 1989, $28.1 million was spent on champs beneficiaries in Europe and in 1988, the Cost was $24.2 million. Champs shares with beneficiaries the expense of health care from civilian hospitals and doctors. For outpatient care families of Active duty service members Are required to pay a $50 to $100 yearly deductible fee depending on the number of family members making claims. The beneficiary then pays 20 percent of the medical Bill. Retirees must pay 25 percent of the Bill. There is no deductible provision for inpatient Hospital care. Families of Active duty members pay $8.35 per Day for a stay in a civilian Hospital the same amount charged for inpatient care at a military Hospital. However there is a minimum charge of $25 for the stay in the civilian Hospital. Retirees and their families pay 25 percent of the total civilian Hospital Bill. Retirees Are no longer covered by champs when they turn age 65 and become eligible for medicare. Although medicare will not cover retirees living overseas champs still cannot cover their medical needs. American family members who use foreign doctors appear to be pleased with the care they receive. Quot i get very few complaints from beneficiaries about the treatment they have received or the amount they have been billed Quot Berlingis said. A it does occur but considering last year we processed nearly 75,000 champs claims the number of complaints is very  records in the states Quot you never know who is going to come through your door Quot Crichlow said. Quot i Deal with complaints but i also assist people. A lot of people need  Crichlow described herself As a bit of a Wheeler dealer when looking for ways to help patients Quot every policy usually has a loophole and that s what i look  for example Crichlow helped a retired army sergeant in his 80s arrange to have a hearing aide fitted at Frankfurt rather than making the Long drive to Lan Stuhl which is the Normal procedure. Crichlow said she must remember that patients Are often frightened and unfamiliar with Hospital procedures and the terminology used by nurses doctors and technicians. Quot this is foreign territory to them Quot Crichlow said. Quot what you have to do is anticipate the patient s questions anticipate the anxiety and go outside of yourself and say what is it this patient is really asking me Quot often the most disgruntled patients Are those who have been Given incomplete or incorrect information. Quot to the patient s credit a lot of times we explain what a going on and they Calm Down Quot Crichlow said. Quot attitudes really change if you keep the Public  Carol Hilt dealing daily with patients frustrations at Lan Stuhl army regional medical Center. A amps Lynda Davidson family member Darlene Kane routinely uses German doctors rather than waiting for appointments in military hospitals. Quot the Quality of care is exceptional Quot said Kane who lives in Munich and has no difficulty finding English speaking doctors. Another plus is that the medical Bills Are less expensive than what she would pay for civilian care in the United states. Anne Fantacone said she does not hesitate to take her children to an italian paediatrician if she cannot get care at the army Hospital in Vicenza. However finding an italian doctor who Speaks English is More difficult says Fantacone who does speak italian. Most champs claims in Europe Are for maternity care because of a shortage of military obstetricians and gynaecologists. Linda Harvey health benefits advisor at the army clinic in Darmstadt helps refer about 15 pregnant women a month to German physicians through the champs system for prenatal care complaints about German medical care whether for outpatient care or hospitalization Are few and Are usually about minor issues such As the food and length of Hospital stay Harvey said. Both Sanders and Kruedelbach said they received excellent care in the German hospitals and would recommend them to other women. However not All americans Are willing to go to a foreign doctor. Quot i prefer to go to someone i can understand and who understands me Quot said Linda Moore. As a civilian Moore realizes she has a Low priority at the air Force Hospital in Wiesbaden but is willing to wait for appointments. Some patients will choose to wait for appointments or will go without medical care rather than visit a German doctor said or. Col Robert Gilmore commander of the Wiesbaden Hospital Quot people Are very sensitive about their health care and they want to go to an american regardless of the Quality of care in the German  while most family members Are pleased with foreign care hospitals sometimes have complaints about americans who leave Europe without paying their share of the Bill. Quot anytime you leave a european provider with a bad debt it leaves a bad taste in his Mouth and As a result subsequent beneficiaries suffer Quot Berlingis said. Some hospitals that have been burned by americans request that the patient pay his portion of the Bill upfront Berlingis said. Few request payment of the entire Bill from champs beneficiaries. Kruedelbach a German paediatrician requests full payment from her american patients. Bui Kruedelbach has had no difficulty being reimbursed by champs she said. Civilian government employees who Are privately insured and choose to go to foreign doctors Are generally required to pay the total medical Bill and Are then reimbursed by their insurance company. At the Friedrich Alexander University Hospital in Erlanger All privately insured patients not Only americans Are asked to pay some portion of the Bill said chief administrator Thomas . Schick. Schick As Well As other German Hospital personnel has contacted Berlingis at the Heidelberg office with questions or problems concerning champs. Those matters have been worked out satisfactorily for both germans and americans Schick said. Health benefits advisors located at most military medical facilities Are available to answer questions and explain champs benefits. Tuesday me26,1990 the stars and stripes a a a Page 15