Specifically, section 733 of the National Defense Authorization Act for Fiscal Years 1992 and 1993 (P. L. 102-190, December 5, 1991) required, among other things, that DOD determine the size and composition of the military medical system needed to support U.S. forces during a war or other conflict and identify ways of improving the cost-effectiveness of medical care delivered during peacetime. Service Models Estimate Medical Personnel Requirements Much Higher Than the 733 Study

Following the 733 study, each service used its own model to determine wartime medical personnel requirements. However, the models’ results depend largely on the values of the input data and assumptions. We found that the services’ modeling techniques were consistent with the 733 study in that they used (1) current defense planning guidance for two MRCs, (2) DOD-approved policies for evacuating casualties from the theater, and (3) casualty projections. These assumptions, not the modeling techniques, accounted for a major difference between the results of the 733 study and the services’ models. The 733 study concluded that about 50 percent of the active duty physicians projected for fiscal year 1999 were not needed to meet wartime medical readiness requirements, while the services’ models supported a need for 96 percent of the fiscal year 1999 active duty physicians. DOD’s current study of medical requirements will examine the appropriateness of the mix between active duty and reserve medical forces. If, for example, the study assumes that medical forces will be needed sooner than assumed in the 733 study, most, if not all, of the reductions in active duty medical personnel estimated in the original study could be nullified. 733 Update Is Using a Process Intended to Supplant Individual Service Models

DOD is currently updating its 733 study using a process intended to replace the individual service models for determining wartime medical personnel requirements. The update was directed by the Deputy Secretary of Defense, in August 1995, to respond to the continuing debate over the estimates for wartime medical personnel. However, the March 1996 completion has been delayed because of disagreements over some assumptions, such as the population-at-risk and casualty rates. DOD officials believe that, in the future, this model—the DOD Medical Sizing Model—will be used to determine total wartime medical personnel levels. Since the update is still ongoing, we are at this time unable to fully assess the reasonableness of the data inputs and assumptions, the appropriateness of the active/reserve component split, and the degree to which DOD integrates the medical requirements of the three services.
Why GAO Did This Study

Pursuant to a legislative requirement, GAO studied the reasonableness of the models each military service uses to determine appropriate wartime medical personnel force levels, focusing on the models' results, their methodologies, and their inclusion of active duty and reserve medical personnel.

What GAO Found

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.