Unique Internal Link - US military health care programs key to attractive compensation and military social contract – complex benefits ensure readiness

[Terri, Carrie, “The US Military Health System: Promoting Readiness And Providing Health Care,” Health Affairs vol 38, no. 8: Military Health Systems, August 2019, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00239, accessed June 19, 2023, GDS-LL]

The US Military Health System (MHS) is charged with simultaneously ensuring the health-related readiness of US armed forces and providing for the health care needs of eligible military personnel and their dependents. This dual mission is complex and requires a sophisticated, agile system that can both sustain the health of the force to meet national security objectives and care for service-related injuries and illnesses and deliver a health care benefit to personnel and their families. These missions are typically referred to as the “readiness mission” and the “benefits mission.” To fulfill these missions, the MHS has a diverse set of assets, including fixed facilities, deployable medical providers and equipment, and a benefit program that delivers services through a mix of care provided at military treatment facilities and via a network of providers in the private sector. In this article we provide a brief history and overview of the MHS, describe its configuration in more detail, and discuss how transformations within the MHS and across the broader US health care system have influenced and shaped this large federal health care system.

A Unique Dual Mission

Readiness Mission

The modern-era MHS has its roots in a demand to tend to war-related wounds as far back as the Revolutionary War.1–3 The young US government took on the responsibility of providing care for acute war injuries for those who served on its behalf. Over time, a system of state-provided care grew into a consolidated, comprehensive federal system that now includes the Department of Defense (DoD); the Department of Veterans Affairs (VA); and continuing support from the Department of Health and Human Services, particularly through the US Public Health Service.

Delivering services to ensure the medical readiness of troops required the implementation of policies and creation of health care capabilities to provide preventive and restorative health care services to military personnel.1,3 Concomitant with its mission of maintaining the medical readiness of the forces, the MHS is also required to maintain a ready medical force that can deliver medical care services in operational contexts (for example, wartime and humanitarian missions).3,4 Maintaining a ready medical force is sometimes referred to as the third mission of the MHS.5 Managing the medical force is the responsibility of the uniformed services: the Army, Navy (which provides medical support to the Marine Corps), and Air Force. Sustaining the skills of this force requires that providers have access to patients with clinical complexity.

Benefits Mission

As early as the mid-1880s uniformed and contracted military doctors tended to some of the non-war-related health care needs of military personnel and their families at no cost, as time and capabilities allowed.1,6 This benefit has grown substantially ever since. Through congressional mandates and the evolution of public laws and DoD regulations,1,6 the US now boasts a substantial health care program for active duty personnel and their families, reserve personnel and their families, and military retirees and their dependents.4,7 The evolution of these benefits has been not only critical for maintaining attractive compensation for military personnel but also vital to the social contract the military has made with its members, particularly since the adoption of an all-volunteer force.9 The size and scope of benefits have been shaped through formally convened panels, commissions, and task forces and also, importantly, through the advocacy efforts of military service organizations, which work with Congress and DoD leaders to ensure that the health care needs of personnel, retirees, and their families remain a top priority.10 These collective efforts have resulted in expanded coverage and low cost-sharing arrangements for beneficiaries.1

The MHS benefits represent a substantial economic investment within the Defense Health Program budget and have been a key driver in increasing DoD appropriations.7,11 Congress retains the responsibility for defining eligibility for health care benefits and outlines what services are covered for whom and under which circumstances, largely through US Code Title X. These benefits have changed considerably over time, largely in response to changes in the national security environment, political climate, and characteristics of the population.