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The Department of Defense (DOD) maintains a substantial health care delivery capability for two reasons — a medical capability supports readiness and provides service members, including retirees and their families, an important compensation benefit. The conflict between these two missions makes the military medical function difficult to size. The readiness mission requires the DOD to maintain an active duty medical establishment that is also able to deliver health services in support of the benefit mission. At issue is how the medical function should share in the military cuts occasioned by changes in the Soviet Union and the collapse of the Warsaw Pact. The authors recommend a thorough quantitative analysis of the size and structure of military medicine. The analysis should simultaneously evaluate a broad range of issues, including (1) wartime requirements evacuation policy, based on the new planning scenarios that are being developed and a reassessment of evacuation policy; (2) CONUS (continental United States) retention policy; (3) the marginal cost of providing non-active-duty care in medical treatment facilities; and (4) the size of graduate medical education programs. Important considerations such as airlift requirements, overall manpower restrictions, budget constraints, roles and missions, and pay and benefits extend the scope of the issue and require broad DOD participation in its evaluation.
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