Military Health System
Encyclopedia
The Military Health System is the enterprise within the United States Department of Defense
responsible for providing health care to active duty
and retired U.S. Military personnel and their dependents
. The mission of the Military Health System (MHS) is to provide health support for the full range of military operations and sustain the health of all who are entrusted to MHS care.
The primary mission of the medical services system is to maintain the health of military personnel, so they can carry out their military missions, and to be prepared to deliver health care required during wartime. Often described as the medical readiness mission, this effort involves medical testing and screening of recruits, emergency medical treatment of servicemen and women involved in hostilities, and the maintenance of physical standards of those in the armed services. In support of those in uniform, the military medical system also provides, where space is available, health care services to dependents of active duty service members. Space available care is also provided to retirees and their dependents. Some former spouses are also included. Since 1966 civilian medical care for dependents of active duty personnel, and for retirees and their dependents who are under age 65 has been available (with certain limitations and co-payments) through the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) and its successor, TRICARE
. Since October 2001 TRICARE benefits have also been available to retirees and their dependents aged 65 and over.
The MHS executes a $42 billion budget and serves approximately 9.5 million beneficiaries, including Active Duty personnel and their families and retirees and their families.The actual cost of having a government run health care system for the military is higher [be]cause the wages and benefits paid for military personnel who work for the MHS and the retirees who formerly worked for it, is not included in the budget. MHS employs more than 137,000 personnel in 65 hospitals, 412 clinics, and 414 dental clinics at facilities across the nation and around the world, as well as in contingency and combat-theater operations worldwide.
Prior to the Civil War
, medical care in the military was provided largely as a function of the regimental surgeon and surgeons mates. While further attempts were made to establish a centralized medical system, care provision was largely local and limited. The availability of effective treatment for disease and injury was, by modern standards, primitive. Significant changes began to occur near the time of the Civil War, when improvements in medical science, communications and transportation made centralized casualty collection and treatment more practical.
In World War I
the U.S. Army Medical Department
expanded and developed greater organization and structure. Care began on the battlefield and was then transferred to successively greater levels of medical capability. Considerable medical service capability was located in the combat theater. This capability was to ensure the availability of needed care, and to help maintain combat unit strength by returning soldiers to duty if their condition could be effectively treated in theater. Expansion continued during World War II
under the necessity to meet changing needs of the war, but without the benefit of an organizational or expansion plan.
After World War II, the Executive Branch of the U.S. Government
underwent significant reorganization. The separate Department of War
and Department of the Navy
were re-aligned under a single Department of Defense. The reorganization created conflict as the Army
had evolved its own medical system, as had the Navy
. Furthermore, the Air Force
, originally part of the Army, was created as a separate military service with its own separate Medical Service
.
Changes in the perception of health care in the post World War II era and an assessment of medical services provided to dependents caused Congress
to re-evaluate the dependent health care benefit in the late 1950s. At that point changes in tax law
had induced business and industry to begin offering a health care benefit as an employment incentive
. A 1956 Department of Defense estimate was that 40 percent of active duty dependents did not have access to federal facilities due to distance, incomplete medical coverage at the federal facility, or due to the saturation of services at military treatment facilities. Congress responded by passing the Dependents Medical Care Act of 1956 and the Military Medical Benefits Amendments of 1966. These acts created the program known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).
In the late 1980s, because of escalating costs, claims paperwork demands and general beneficiary dissatisfaction, DOD initiated a series of demonstration projects. Under a program known as the CHAMPUS Reform Initiative (CRI), a contractor provided both health care and administrative-related services, including claims processing. The CRI project was one of the first to introduce managed care features to the CHAMPUS program. Beneficiaries under CRI were offered three choices a health maintenance organization-like option called CHAMPUS Prime that required enrollment and offered enhanced benefits and low-cost shares, a preferred provider organization-like option called CHAMPUS Extra that required use of network providers in exchange for lower cost shares, and the standard CHAMPUS option that continued the freedom of choice in selecting providers and higher cost shares and deductibles.
Although DOD’s initial intent under CRI was to award three competitively bid contracts covering six states, only one bid, made by Foundation Health Corporation (now Health Net
) covering California
and Hawaii
, was received. Foundation delivered services under this contract between August 1988 and January 1994.
In late 1993, in response to requirements in the DOD Appropriation Act for Fiscal Year 1994, the DOD announced plans for implementing a nationwide managed care program for the MHS that would be completely implemented by May 1997. Under this program, known as TRICARE
, the United States
would be divided into 12 health care regions. An administrative organization, the lead agent, was designated for each region and coordinated the health care needs of all military treatment facilities in the region. Under TRICARE, seven managed care support contracts were awarded covering DOD’s 12 health care regions.
Since then, TRICARE has undergone several restructuring initiatives, including re-alignment of contract regions, Base Realignment and Closure
, and the addition of "TRICARE for Life" benefits in 2001 for those who are Medicare
-eligible, and "TRICARE Reserve Select" in 2005.
, the Military Health System includes several core organizational areas including:
The MHS also includes the medical departments of the Army, Navy, Marine Corps, Air Force, Coast Guard, and Joint Chiefs of Staff; the Combatant Command surgeons; and TRICARE providers (including private sector healthcare providers, hospitals and pharmacies).
United States Department of Defense
The United States Department of Defense is the U.S...
responsible for providing health care to active duty
Active duty
Active duty refers to a full-time occupation as part of a military force, as opposed to reserve duty.-Pakistan:The Pakistan Armed Forces are one of the largest active service forces in the world with almost 610,000 full time personnel due to the complex and volatile nature of Pakistan's...
and retired U.S. Military personnel and their dependents
Dependant
This article is related to law. For the personality trait, see Dependent Personality DisorderA dependant or dependent is a person who relies on another as a primary source of income...
. The mission of the Military Health System (MHS) is to provide health support for the full range of military operations and sustain the health of all who are entrusted to MHS care.
The primary mission of the medical services system is to maintain the health of military personnel, so they can carry out their military missions, and to be prepared to deliver health care required during wartime. Often described as the medical readiness mission, this effort involves medical testing and screening of recruits, emergency medical treatment of servicemen and women involved in hostilities, and the maintenance of physical standards of those in the armed services. In support of those in uniform, the military medical system also provides, where space is available, health care services to dependents of active duty service members. Space available care is also provided to retirees and their dependents. Some former spouses are also included. Since 1966 civilian medical care for dependents of active duty personnel, and for retirees and their dependents who are under age 65 has been available (with certain limitations and co-payments) through the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) and its successor, TRICARE
TRICARE
TRICARE, formerly known as the Civilian Health and Medical Program of the Uniformed Services , is a health care program of the United States Department of Defense Military Health System. TRICARE provides civilian health benefits for military personnel, military retirees, and their dependents,...
. Since October 2001 TRICARE benefits have also been available to retirees and their dependents aged 65 and over.
The MHS executes a $42 billion budget and serves approximately 9.5 million beneficiaries, including Active Duty personnel and their families and retirees and their families.The actual cost of having a government run health care system for the military is higher [be]cause the wages and benefits paid for military personnel who work for the MHS and the retirees who formerly worked for it, is not included in the budget. MHS employs more than 137,000 personnel in 65 hospitals, 412 clinics, and 414 dental clinics at facilities across the nation and around the world, as well as in contingency and combat-theater operations worldwide.
History
American Civil War
The American Civil War was a civil war fought in the United States of America. In response to the election of Abraham Lincoln as President of the United States, 11 southern slave states declared their secession from the United States and formed the Confederate States of America ; the other 25...
, medical care in the military was provided largely as a function of the regimental surgeon and surgeons mates. While further attempts were made to establish a centralized medical system, care provision was largely local and limited. The availability of effective treatment for disease and injury was, by modern standards, primitive. Significant changes began to occur near the time of the Civil War, when improvements in medical science, communications and transportation made centralized casualty collection and treatment more practical.
In World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
the U.S. Army Medical Department
Army Medical Department (United States)
The Army Medical Department of the U.S. Army – known as the AMEDD – comprises the Army's six medical Special Branches of officers and medical enlisted soldiers. It was established as the "Army Hospital" in July 1775 to coordinate the medical care required by the Continental Army during the...
expanded and developed greater organization and structure. Care began on the battlefield and was then transferred to successively greater levels of medical capability. Considerable medical service capability was located in the combat theater. This capability was to ensure the availability of needed care, and to help maintain combat unit strength by returning soldiers to duty if their condition could be effectively treated in theater. Expansion continued during World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
under the necessity to meet changing needs of the war, but without the benefit of an organizational or expansion plan.
After World War II, the Executive Branch of the U.S. Government
Federal government of the United States
The federal government of the United States is the national government of the constitutional republic of fifty states that is the United States of America. The federal government comprises three distinct branches of government: a legislative, an executive and a judiciary. These branches and...
underwent significant reorganization. The separate Department of War
United States Department of War
The United States Department of War, also called the War Department , was the United States Cabinet department originally responsible for the operation and maintenance of the United States Army...
and Department of the Navy
United States Department of the Navy
The Department of the Navy of the United States of America was established by an Act of Congress on 30 April 1798, to provide a government organizational structure to the United States Navy and, from 1834 onwards, for the United States Marine Corps, and when directed by the President, of the...
were re-aligned under a single Department of Defense. The reorganization created conflict as the Army
United States Army
The United States Army is the main branch of the United States Armed Forces responsible for land-based military operations. It is the largest and oldest established branch of the U.S. military, and is one of seven U.S. uniformed services...
had evolved its own medical system, as had the Navy
United States Navy
The United States Navy is the naval warfare service branch of the United States Armed Forces and one of the seven uniformed services of the United States. The U.S. Navy is the largest in the world; its battle fleet tonnage is greater than that of the next 13 largest navies combined. The U.S...
. Furthermore, the Air Force
United States Air Force
The United States Air Force is the aerial warfare service branch of the United States Armed Forces and one of the American uniformed services. Initially part of the United States Army, the USAF was formed as a separate branch of the military on September 18, 1947 under the National Security Act of...
, originally part of the Army, was created as a separate military service with its own separate Medical Service
Air Force Medical Service
The United States Air Force Medical Service consists of the five distinct medical corps of the Air Force and enlisted medical technicians. The AFMS was created in 1949 after the newly independent Air Force’s first Surgeon General, Maj. General Malcolm C. Grow , convinced the United States Army...
.
Changes in the perception of health care in the post World War II era and an assessment of medical services provided to dependents caused Congress
United States Congress
The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....
to re-evaluate the dependent health care benefit in the late 1950s. At that point changes in tax law
Tax law
Tax law is the codified system of laws that describes government levies on economic transactions, commonly called taxes.-Major issues:Primary taxation issues facing the governments world over include;* taxes on income and wealth...
had induced business and industry to begin offering a health care benefit as an employment incentive
Incentive
In economics and sociology, an incentive is any factor that enables or motivates a particular course of action, or counts as a reason for preferring one choice to the alternatives. It is an expectation that encourages people to behave in a certain way...
. A 1956 Department of Defense estimate was that 40 percent of active duty dependents did not have access to federal facilities due to distance, incomplete medical coverage at the federal facility, or due to the saturation of services at military treatment facilities. Congress responded by passing the Dependents Medical Care Act of 1956 and the Military Medical Benefits Amendments of 1966. These acts created the program known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).
In the late 1980s, because of escalating costs, claims paperwork demands and general beneficiary dissatisfaction, DOD initiated a series of demonstration projects. Under a program known as the CHAMPUS Reform Initiative (CRI), a contractor provided both health care and administrative-related services, including claims processing. The CRI project was one of the first to introduce managed care features to the CHAMPUS program. Beneficiaries under CRI were offered three choices a health maintenance organization-like option called CHAMPUS Prime that required enrollment and offered enhanced benefits and low-cost shares, a preferred provider organization-like option called CHAMPUS Extra that required use of network providers in exchange for lower cost shares, and the standard CHAMPUS option that continued the freedom of choice in selecting providers and higher cost shares and deductibles.
Although DOD’s initial intent under CRI was to award three competitively bid contracts covering six states, only one bid, made by Foundation Health Corporation (now Health Net
Health Net
Health Net, Inc. is among the United States of America's largest publicly traded health insurers. The company’s HMO, POS, insured PPO and government contracts subsidiaries provide health benefits to approximately 6.6 million individuals in all 50 states and the District of Columbia through group,...
) covering California
California
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...
and Hawaii
Hawaii
Hawaii is the newest of the 50 U.S. states , and is the only U.S. state made up entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean, southwest of the continental United States, southeast of Japan, and northeast of...
, was received. Foundation delivered services under this contract between August 1988 and January 1994.
In late 1993, in response to requirements in the DOD Appropriation Act for Fiscal Year 1994, the DOD announced plans for implementing a nationwide managed care program for the MHS that would be completely implemented by May 1997. Under this program, known as TRICARE
TRICARE
TRICARE, formerly known as the Civilian Health and Medical Program of the Uniformed Services , is a health care program of the United States Department of Defense Military Health System. TRICARE provides civilian health benefits for military personnel, military retirees, and their dependents,...
, the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
would be divided into 12 health care regions. An administrative organization, the lead agent, was designated for each region and coordinated the health care needs of all military treatment facilities in the region. Under TRICARE, seven managed care support contracts were awarded covering DOD’s 12 health care regions.
Since then, TRICARE has undergone several restructuring initiatives, including re-alignment of contract regions, Base Realignment and Closure
Base Realignment and Closure
Base Realignment and Closure is a process of the United States federal government directed at the administration and operation of the Armed Forces, used by the United States Department of Defense and Congress to close excess military installations and realign the total asset inventory to reduce...
, and the addition of "TRICARE for Life" benefits in 2001 for those who are Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
-eligible, and "TRICARE Reserve Select" in 2005.
Components
Led by the Office of the Assistant Secretary of Defense for Health AffairsAssistant Secretary of Defense for Health Affairs
The Assistant Secretary of Defense for Health Affairs is chartered under United States Department of Defense Directive 5136.1 in 1994. This DoDD states that the ASD is the principal advisor to the U.S...
, the Military Health System includes several core organizational areas including:
- TRICARE/TRICARE Management ActivityTRICARETRICARE, formerly known as the Civilian Health and Medical Program of the Uniformed Services , is a health care program of the United States Department of Defense Military Health System. TRICARE provides civilian health benefits for military personnel, military retirees, and their dependents,...
(TMA) - Force Health Protection and Readiness (FHP&R)
- Uniformed Services University of the Health SciencesUniformed Services University of the Health SciencesThe Uniformed Services University of the Health Sciences is a health science university run by the U.S. federal government. The primary mission of the school is to prepare graduates for service to the U.S. at home and abroad in the medical corps....
(USU) - Defense Centers of Excellence for Psychological Health and Traumatic Brain InjuryDefense Centers of Excellence for Psychological Health and Traumatic Brain InjuryThe Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury is a United States Department of Defense organization that provides guidance across DoD programs related to psychological health and traumatic brain injury issues...
(DCOE) - Office of the Chief Information Officer (MHS-OCIO)
The MHS also includes the medical departments of the Army, Navy, Marine Corps, Air Force, Coast Guard, and Joint Chiefs of Staff; the Combatant Command surgeons; and TRICARE providers (including private sector healthcare providers, hospitals and pharmacies).
Facilities
See :Category:United States military medical facilities.See also
- Assistant Secretary of Defense for Health AffairsAssistant Secretary of Defense for Health AffairsThe Assistant Secretary of Defense for Health Affairs is chartered under United States Department of Defense Directive 5136.1 in 1994. This DoDD states that the ASD is the principal advisor to the U.S...
- Military medicineMilitary medicineThe term military medicine has a number of potential connotations. It may mean:*A medical specialty, specifically a branch of occupational medicine attending to the medical risks and needs of soldiers, sailors and other service members...
- Surgeon General of the United States Army
- Surgeon General of the United States NavySurgeon General of the United States NavyThe Surgeon General of the United States Navy is the senior-most medical corps officer in the United States Navy.- Establishment of the Bureau of Medicine and Surgery :...
- Surgeon General of the United States Air ForceSurgeon General of the United States Air ForceThe Surgeon General of the United States Air Force is the senior-most Medical Service officer in the U.S. Air Force. In recent times, this has been a Lieutenant General who serves as head of the United States Air Force Medical Service...
- TRICARETRICARETRICARE, formerly known as the Civilian Health and Medical Program of the Uniformed Services , is a health care program of the United States Department of Defense Military Health System. TRICARE provides civilian health benefits for military personnel, military retirees, and their dependents,...
- http://en.wikipedia.org/wiki/Uniformed_Services_University_of_the_Health_Sciences
- US Family Health PlanUS Family Health PlanThe US Family Health Plan is a U.S. Department of Defense-sponsored healthcare plan that serves military family members exclusively. Current regional coverage includes: northeastern United States, southeast Texas and southwest Louisiana, and the Puget Sound area of Washington...
External links
- Military Health System
- TRICARE/TRICARE Management Activity (TMA)
- Force Health Protection and Readiness (FHP&R)
- Uniformed Services University for the Health Sciences (USU)
- Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCOE)
- Office of the Chief Information Officer (MHS-OCIO)