Wartime Medical Care

Since 1994, the Defense Department (DOD) and the military services have produced several estimates of wartime medical personnel requirements. The National Defense Authorization Act of 1996 requires GAO to study the reasonableness of the models each military service uses to determine appropriate wartime medical personnel force levels. DOD recently embarked on, but has yet to complete, another major wartime medical requirements study. This study is expected to modify the data contained in the service models and is intended to produce a unified DOD position on medical requirements. This report addresses the service models' results, their methodologies, and their inclusion of active duty and reserve medical personnel. A separate report will examine DOD's updated wartime medical requirements study and, to the extent needed, address any remaining issues associated with the service models.

GAO found that: (1) in 1995, each service used its own model to determine wartime medical personnel requirements instead of adopting the results of the Department of Defense's (DOD) "733 study," which, among other things, sought to determine the size and composition of the military medical system needed to support U.S. forces during a war or other conflict; (2) taken together, the services' models offset nearly all of the reductions estimated in the 733 study, supporting instead, a need for about 96 percent of the active duty physicians projected for fiscal year (FY) 1999; (3) much of this difference resulted because the services assumed that significantly more people were needed for training and maintaining personnel to relieve deployed medical forces; (4) given these results, DOD has not planned significant reductions in future medical forces; (5) by comparison, the overall DOD active duty end strengths are expected to decline by twice the rate of decline in medical forces from FY 1987 to FY 1999; (6) the modeling techniques the services used to determine medical requirements appear reasonable; (7) however, the results of the models depend largely on the values of the input data and assumptions used; (8) although their techniques differed in some ways, the services appropriately considered factors, such as current defense planning guidance, DOD policies for evacuating patients from the theater, and casualty projections; (9) the service models also included requirements for both active duty and reserve medical personnel; (10) at the time of GAO's review, the services had done more detailed analyses of the active duty requirements than the reserve portion; (11) given the dichotomy between the results of the service models and the 733 study, in August 1995, the Deputy Secretary of Defense directed that the 733 study be updated and improved; (12) this ongoing study is intended to form the basis for a single DOD position on wartime medical demands and associated personnel; (13) as such, it is to resolve differences in the key assumptions that drive medical force requirements; (14) while the study was to be completed by March 1996, DOD has encountered difficulty in reaching agreement over some assumptions, such as the population-at-risk and casualty rates, and thus, the study has been delayed; and (15) the 733 update is using a unified DOD sizing model, which will supplant individual service models.