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<div>The Department of Defense’s (DOD) military health system (MHS), costing</div><div>about $16 billion annually, offers care to 8.2 million military and civilian</div><div>beneficiaries. The system has a dual role of medically supporting wartime</div><div>deployments—its readiness mission—while caring for active duty</div><div>members, retirees, and their families in peacetime. The Army, Navy, and</div><div>Air Force provide most of the system’s care through their own medical</div><div>centers, hospitals, and clinics, totaling about 580 treatment facilities</div><div>worldwide. Regional networks of civilian providers supply the remaining</div><div>care. MHS has undergone major demographic changes and, today, serves</div><div>more retirees than active duty beneficiaries and their respective families.</div><div>Also, mirroring overall military end-strength decreases during this decade,</div><div>military treatment facilities (MTF) have been closed or downsized, their</div><div>budgets constrained, and medical practices shifted toward an emphasis on</div><div>managed care. Such conditions have focused attention on the prospective</div><div>need for MTFs, the coordination of peacetime care among them, and</div><div>alternative care delivery approaches.</div><div><br></div><div>Among the areas affected by the changes is the national capital area (NCA),</div><div>in and around Washington, D.C. There, the three services offer care to</div><div>about 400,000 beneficiaries in 26 MTFs, including 3 medical centers.</div><div>Concerned about potential service overlaps and whether increased</div><div>efficiencies are possible, the Congress, in the 1998 Defense Authorization</div><div>Act mandated that we review the need for and coordination of care among<br></div><div>NCA MTFs. This review is the second of two GAO reviews mandated by the</div><div>act. In the first review, we examined the Navy’s and Army’s attempts in</div><div>1997 to downsize and close certain graduate medical education</div><div>programs—the primary source of military physicians. In the resulting</div><div>April 1998 report, we found that DOD and the two services lacked mutually</div><div>acceptable criteria and methods for targeting the graduate medical</div><div>education programs. DOD agreed with our recommendation to develop the</div><div>needed guidance and is now doing so.</div><div><br></div><div>As agreed with your offices, this review’s objectives are to (1) evaluate the</div><div>need for NCA MTFs and DOD’s strategy for assessing such needs, (2) identify any obstacles hindering DOD’s ability to make coherent needs assessments, and (3) determine whether current care coordination among NCA MTFs could be improved. We also agreed that, because NCA MTFs are integral parts of the overall MHS, we would assess recent DOD initiatives to make MHS management improvements. We conducted our work between</div><div>March 1998 and September 1999 in accordance with generally accepted</div><div>government auditing standards. For details on our methodology, see</div><div>appendix I.</div>
<br>Subjects: Tricare; BUMED; Walter Reed Army Medical Center; Naval National Medical Center</div>
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U.S. General Accounting Office</div>
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