Defense Health Care

The Department of Defense (DOD) needs to apply a tri-service strategy nationwide to account for the resources its military treatment facilities in the national capital area need for both readiness and peacetime care. By also considering resources available in the local civilian community, DOD would then have a systematic basis to justify budget requests. In the 1990s, DOD and the services' surgeons general implemented DOD's managed care program, reduced the number of medical personnel, consolidated graduate medical education programs, established partnerships with the Department of Veterans Affairs, and undertook several other improvement initiatives. Recent efforts include a project to develop a tri-service strategy to account for current and projected beneficiary populations, focus on the military health system's basic wartime and peacetime care missions, and optimally seek to realign military treatment facilities' staffing and resource allocations. GAO suggests that DOD top management continue to scrutinize this project and periodically report to Congress on progress being made.

GAO noted that: (1) despite successful DOD and service efforts to improve MHS management, DOD still lacks a comprehensive tri-service strategy for determining and allocating medical resources among MTFs; (2) consequently, neither GAO nor DOD can fully address the need for, or appropriate size of NCA MTFs or MTFs elsewhere in MHS; (3) a tri-service strategy applied systemwide would enable DOD to assess the need for each MTF by taking into account the resources needed for both readiness and peacetime care available at all NCA MTFs; (4) also, resources available in the local civilian community need to be considered; (5) such a strategy would also provide a systematic basis for justifying budget requests; (6) DOD has recently begun to address this fundamental deficiency; (7) a key obstacle to developing a tri-service strategy is the military services' long-standing independence; (8) historically, the services have had enough resources to maintain separate health care systems, with capabilities overlapping during peacetime; (9) as a result, over the years, formal interservice management efforts have been limited and, today, remain difficult to achieve; (10) a second obstacle is that DOD and the services have not determined the cost of MHS' evolving readiness mission or the cost of its peacetime care; (11) without knowing such costs, DOD is hampered in justifying MHS' size and defending the need for individual MTFs; (12) exacerbating this has been the emerging peacetime care emphasis during this decade--projected to continue in the next--which competes for resources with MHS' basic readiness mission; (13) regarding service coordination with NCA, GAO found that MTFs have entered into numerous, varying agreements to share resources; (14) such ad hoc agreements are vulnerable to changes in MTF budgeting approaches and other factors that can affect the MTFs' willingness to coordinate their efforts; (15) DOD and the services' Surgeons General have undertaken improvement initiatives, including implementing DOD's managed care program, TRICARE; reducing the number of medical personnel; consolidating graduate medical education programs; establishing partnerships with the Department of Veterans Affairs; reducing hospital stays; restructuring hospitals into more efficient clinics; and revising budget processes to more closely link funding to cost-effective health care; and (16) among these the most critical in GAO's and DOD's view is to develop a tri-service strategy that takes into account current and projected beneficiary populations and optimally seeks to realign MTF staffing and resource allocations.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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