Reorganizing the Military Health System

Should There Be a Joint Command?

by Susan D. Hosek, Gary Cecchine

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Since the end of World War II, the question of whether to create a unified military health system has arisen repeatedly. Despite a variety of answers to this question, the system has largely retained its traditional structure, with separate Army, Navy, and Air Force medical departments. Now that a new managed-care program — called TRICARE — is operational, the military health system organization is once again in the spotlight. This book documents research on the organization of the military health system. It considers five alternative organizational structures for their likely impact on peacetime health care and wartime readiness. It also examines organizational models in the civilian managed-care sector that might be applied to TRICARE. The authors recommend modification of the current system organization to unify health-plan management in TRICARE and separate it from military treatment facility management. The authors also find that there is insufficient evidence to predict the necessity or effectiveness of establishing a joint command to direct the restructured TRICARE organization and other military medical activities. The outcome of a regional test, now underway, can better inform this decision.

Table of Contents

  • Preface

  • Figures

  • Tables

  • Summary

  • Acknowledgements

    Acknowledgments

  • Acronyms

  • Chapter One

    Introduction and Background

  • Chapter Two

    Options for Organizing the Military Health System

  • Chapter Three

    Organization in the Private Sector and TRICARE

  • Chapter Four

    Medical Readiness and Operational Medicine

  • Chapter Five

    Other Assessments of the MHS Organization

  • Chapter Six

    Assessing the Organizational Alternatives

  • Appendix A

    Unifying the Training Curriculum

  • Appendix B

    Principles of Organizational Structure

  • Appendix C

    Interviewee List

  • Bibliography

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This research was conducted within RAND's National Security Research Division and RAND Health.

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