{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:29:13Z","timestamp":1791599353132,"version":"4.3.4"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"9-10","funder":[{"DOI":"10.13039\/100009898","name":"Defense Health Agency","doi-asserted-by":"publisher","award":["HT94022210005"],"award-info":[{"award-number":["HT94022210005"]}],"id":[{"id":"10.13039\/100009898","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009898","name":"Defense Health Agency","doi-asserted-by":"publisher","award":["HQ00342010001"],"award-info":[{"award-number":["HQ00342010001"]}],"id":[{"id":"10.13039\/100009898","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009898","name":"Defense Health Agency","doi-asserted-by":"publisher","award":["HT94022210005"],"award-info":[{"award-number":["HT94022210005"]}],"id":[{"id":"10.13039\/100009898","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009898","name":"Defense Health Agency","doi-asserted-by":"publisher","award":["HQ00342010001"],"award-info":[{"award-number":["HQ00342010001"]}],"id":[{"id":"10.13039\/100009898","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>There is a longstanding debate about whether health care is more efficiently provided by the public or private sector. The debate is particularly relevant to the Military Health System (MHS), which delivers care through a combination of publicly funded federal facilities and privately contracted providers. This study compares outcomes, treatments, and costs for MHS patients obtaining care for low back pain (LBP) from public versus private providers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>A retrospective cohort study was completed using TRICARE Prime claims data from April 2015 to December 2018. The cohort was identified using International Classification of Diseases Ninth Revision and Tenth Revision diagnostic codes and then followed for 12\u2009months after the index diagnosis to assess treatments, outcomes, and costs. Claims were classified as originating from either public or private providers. The primary outcome measure was resolution of LBP, defined as an absence of LBP diagnoses during the 6-to-12-month window following the index event. Instrumental variable models were used to assess the impact of care setting (i.e., private versus public), conditioning on the covariates. A regional measure of the fraction of private care was used as an instrument.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Resolution of LBP was achieved for 79.7% of 144,866 patients in the cohort. No significant association was found between resolution of LBP and fraction of privately provided care. Higher fraction of private care was associated with a greater likelihood of opioid treatments (odds ratio, 1.22; 95% CI, 1.02-1.46) and a lower likelihood of benzodiazepine (odds ratio, 0.56; 95% CI, 0.45-0.70) and physical therapy (odds ratio 0.55; 95% CI, 0.42-0.74) treatments; manual therapy was not significantly associated with the fraction of private care. There was a significant negative association between the fraction of private care and cost (coefficient \u22120.27; 95% CI, \u22120.44, \u22120.10).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study found that privately provided care was associated with significantly higher opioid prescribing, less use of benzodiazepines and physical therapy, and lower costs. No systematic differences in outcomes (as measured by resolved cases) were identified. The findings suggest that publicly funded health care within the MHS context can attain quality comparable to privately provided care, although differences in treatment choices and costs point to possibilities for improved care within both systems.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae074","type":"journal-article","created":{"date-parts":[[2024,3,16]],"date-time":"2024-03-16T16:01:34Z","timestamp":1710604894000},"page":"e2170-e2176","source":"Crossref","is-referenced-by-count":3,"title":["Public versus Private Care in the Military Health System: Evidence From Low Back Pain Patients"],"prefix":"10.1093","volume":"189","author":[{"given":"Christopher G","family":"Leggett","sequence":"first","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth Hitchcock Medical Center, One Medical Center Drive , Lebanon, NH 03756, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel O","family":"Schmidt","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth Hitchcock Medical Center, One Medical Center Drive , Lebanon, NH 03756, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Skinner","sequence":"additional","affiliation":[{"name":"Department of Economics, Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, and the National Bureau of Economic Research , Hanover, NH 03755, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon D","family":"Lurie","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine, Dartmouth Hitchcock Medical Center, One Medical Center Drive , Lebanon, NH 03756, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4731-937X","authenticated-orcid":false,"given":"William Patrick","family":"Luan","sequence":"additional","affiliation":[{"name":"Cost Analysis and Research Division, Institute for Defense Analyses , Alexandria, VA 22305-3086, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,16]]},"reference":[{"issue":"11","key":"2024083012294027800_R1","doi-asserted-by":"publisher","first-page":"3003","DOI":"10.1257\/aer.20211638","article-title":"Is there a VA advantage? Evidence from dually eligible veterans","volume":"113","author":"Chan","year":"2023","journal-title":"Am Econ Rev"},{"issue":"4","key":"2024083012294027800_R2","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1257\/pol.20210625","article-title":"Public and private options in practice: the military health system","volume":"15","author":"Frakes","year":"2023","journal-title":"Am Econ J Econ Policy"},{"issue":"4","key":"2024083012294027800_R3","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1097\/BRS.0000000000004639","article-title":"A regional analysis of low back pain treatments in the military health system","volume":"49","author":"Lurie","year":"2024","journal-title":"Spine"},{"issue":"7","key":"2024083012294027800_R4","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1089\/acm.2017.0290","article-title":"Associations of early treatments for low-back pain with military readiness outcomes","volume":"24","author":"Larson","year":"2017","journal-title":"J Altern Complement Med"},{"issue":"19","key":"2024083012294027800_R5","doi-asserted-by":"publisher","first-page":"E995","DOI":"10.1097\/BRS.0b013e3181c6edbb","article-title":"The effect of low back pain on work absenteeism among soldiers on active service","volume":"35","author":"Eilat-Tsanani","year":"2010","journal-title":"Spine"},{"issue":"5\u20136","key":"2024083012294027800_R6","doi-asserted-by":"publisher","first-page":"e662","DOI":"10.1093\/milmed\/usz487","article-title":"The opioid epidemic: challenge to military medicine and national security","volume":"185","author":"Dembek","year":"2020","journal-title":"Mil Med"},{"key":"2024083012294027800_R7","doi-asserted-by":"crossref","DOI":"10.3386\/w30110","article-title":"Opioid use and employment outcomes: evidence from the U.S. military","volume-title":"NBER Working Paper Series","author":"Alpert","year":"2022"},{"key":"2024083012294027800_R8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g6380","article-title":"Opioids for low back pain","volume":"350","author":"Deyo","year":"2015","journal-title":"Br Med J"},{"issue":"10398","key":"2024083012294027800_R9","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/S0140-6736(23)00404-X","article-title":"Opioid analgesia for acute low back pain and neck pain","volume":"402","author":"Jones","year":"2023","journal-title":"Lancet"},{"issue":"4","key":"2024083012294027800_R10","first-page":"435","article-title":"Management of low back pain: guidelines from the VA\/DoD","volume":"107","author":"Buelt","year":"2023","journal-title":"Am Fam Physician"},{"issue":"2","key":"2024083012294027800_R11","first-page":"2115","article-title":"Physical therapy for low back pain","volume":"98","author":"Lyon","year":"2018","journal-title":"Am Fam Physician"},{"issue":"4","key":"2024083012294027800_R12","first-page":"248","article-title":"Manipulative therapies: what works","volume":"99","author":"Smith","year":"2019","journal-title":"Am Fam Physician"},{"key":"2024083012294027800_R13","article-title":"Report to the Congress: Medicare Payment Policy","author":"Medicare Payment Advisory Commission (MedPAC)","year":"2019"},{"issue":"7","key":"2024083012294027800_R14","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.1111\/add.15359","article-title":"Laws limiting prescribing and dispensing of opioids in the United States, 1989-2019","volume":"116","author":"Davis","year":"2021","journal-title":"Addiction"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/9-10\/e2170\/58971022\/usae074.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/9-10\/e2170\/58971022\/usae074.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T13:41:04Z","timestamp":1725025264000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/189\/9-10\/e2170\/7630441"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,16]]},"references-count":14,"journal-issue":{"issue":"9-10","published-online":{"date-parts":[[2024,3,16]]},"published-print":{"date-parts":[[2024,8,30]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usae074","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,9]]},"published":{"date-parts":[[2024,3,16]]}}}