In this report, the authors evaluate health care access for U.S. Coast Guard beneficiaries. The authors find that a minority of specialty care referrals meet access standards. The authors suggest collaborating with the Defense Health Agency to tackle low access and fielding stakeholder surveys to understand care barriers and readiness impacts to help the Coast Guard establish where more organic care is needed to ensure readiness.

Health Services for Coast Guard Beneficiaries

Improving Access to Care for Active Duty Service Members, Reservists, Dependents, and Retirees

Catherine C. Cohen, Edward W. Chan, Patricia K. Tong, Peggy G. Chen, Jason Michel Etchegaray, Christina Freibott, Travis Hubble, Kyung Jin Kim, Candice Miller, Kristin J. Leuschner, et al.

ResearchPublished May 29, 2025

In this report, the authors evaluate access to health care services for U.S. Coast Guard beneficiaries (active duty service members, reservists, retirees, and dependents). The authors highlight challenges in obtaining timely care within standards set by the Defense Health Agency (DHA).

The authors’ analysis of health care appointment and enrollment data, alongside feedback from key stakeholders, reveals that access issues are a significant concern that may affect medical readiness. The report identifies data gaps that hinder effective understanding and resolution of access challenges.

The authors emphasize the need for collaboration between the Coast Guard and DHA to identify and address locations with low access to care and monitor ongoing access issues. Additionally, the authors recommend implementing a systematic survey to better gauge beneficiaries’ experiences, creating enhanced internal capabilities for tracking access, and addressing barriers specific to reservists and retirees. These capabilities and more-complete data will allow the Coast Guard to systematically determine when it should provide more care to beneficiaries organically to safeguard mission readiness.

Effective health care access is crucial for the medical readiness of service members. The Coast Guard is responsible for the care of dependents and retirees. The findings of this report should be of interest to Coast Guard leadership and policymakers aiming to efficiently direct resources to support readiness.

Key Findings

  • Coast Guard beneficiaries struggle to access care that meets standards. About 40 percent of TRICARE Prime referrals meet access standards; Coast Guard clinics and U.S. Department of Defense medical treatment facilities, depending on location, meet standards 60 percent to 80 percent of the time. Only 46 percent of 24-hour appointments at clinics meet access criteria. Data gaps understate access issues.
  • Gaps in data hinder understanding of access challenges. Metrics for nonreferral appointments cannot be computed, and geographical information on private-sector referrals is insufficient.
  • Staffing shortages at Coast Guard clinics impede access because of insufficient billets and vacancies. The deployment of medical personnel further reduces staff availability.
  • Interviewees reported that access affects readiness, although linking access issues directly to readiness is difficult because of a lack of systematic data linking care access to readiness.
  • The Coast Guard lacks visibility regarding active duty dependents eligible for, but not enrolled in, the Special Needs Program (SNP), negatively affecting family readiness.
  • The SNP and Overseas Screening processes may be outdated and do not accurately reflect current access to care.
  • Reservists face barriers to Periodic Health Assessments and Line of Duty (LOD) determinations because of ambiguous guidance and scheduling difficulties.
  • The process for reservists’ LOD determinations is cumbersome, complicating access to care.
  • Retirees experience confusion regarding health benefits and spend excessive time resolving questions because of fragmented information sources.

Recommendations

  • The Coast Guard should document access problems and elevate them to DHA. The Coast Guard should engage DHA on access problems in TRICARE Prime and Prime Remote using report statistics and ensure that existing billets in Coast Guard clinics are filled.
  • The Coast Guard needs to develop an internal capability to monitor access to care, which will require staff with programming knowledge. DHA should be asked to create reports specifically on Coast Guard beneficiaries, and clinic operational statuses must be monitored for mission capability.
  • Measurements should be established for the number of days a patient must wait for an appointment, such as assessing third-next-available-appointment data. Additionally, location information on TRICARE Prime Remote referrals for specialty care is necessary.
  • The Coast Guard should survey unit leaders regarding health care delays and their effects on mission readiness. This effort would also include collecting data on lost productivity resulting from access issues.
  • The Coast Guard might consider providing organic care if external improvements are insufficient and should assess costs and acceptable risk to mission readiness in the process.
  • A survey should be fielded to gather information on access experiences from active duty service members, reservists, and dependents, including details on appointments, referrals, and time lost.
  • An anonymous survey should be conducted among active duty households to gauge family SNP eligibility and willingness to join.
  • It is important to include retirees in a survey to understand their experiences and identify sources of confusion regarding health benefits.
  • The Coast Guard should revise SNP assignment processes to reflect current access evaluations and tailor assignments based on dependents’ health needs.
  • The Coast Guard must clarify access policies regarding reservists’ Periodic Health Assessments and automate LOD eligibility to improve the process.

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Cohen, Catherine C., Edward W. Chan, Patricia K. Tong, Peggy G. Chen, Jason Michel Etchegaray, Christina Freibott, Travis Hubble, Kyung Jin Kim, Candice Miller, Kristin J. Leuschner, and Teague Ruder, Health Services for Coast Guard Beneficiaries: Improving Access to Care for Active Duty Service Members, Reservists, Dependents, and Retirees. Homeland Security Operational Analysis Center operated by the RAND Corporation, 2025. https://www.rand.org/pubs/research_reports/RRA3018-1.html.
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This research was sponsored by USCG and conducted in the Infrastructure, Immigration, and Security Operations Program of the RAND Homeland Security Research Division, which operates HSOAC.

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