Military Health System

Health care system for the U.S. military

Military Health System

Agency overview
Headquarters| Falls Church, VA
Employees| 137,000
Annual budget| $50 billion
Agency executive|

* Ms. Seileen Mullen, Acting Assistant Secretary of Defense for Health Affairs

Website| health.mil

The Military Health System (MHS) is the internal health care system operated within the United States Department of Defense that provides health care to active duty, Reserve component and retired U.S. Military personnel and their dependents.[1]

The missions of the MHS are complex and interrelated:[2]

* To ensure America’s 1.4 million active duty and 331,000 reserve-component personnel are healthy so they can complete their national security missions.
* To ensure that all active and reserve medical personnel in uniform are trained and ready to provide medical care in support of operational forces around the world.
* To provide a medical benefit commensurate with the service and sacrifice of more than 9.5 million active duty personnel, military retirees and their families.

The MHS also provides health care, through the TRICARE health plan, to:[3]

* active duty service members and their families,
* retired service members and their families,
* Reserve component members and their families,
* surviving family members,
* Medal of Honor recipients and their families
* some former spouses, and
* others identified as eligible in the Defense Enrollment Eligibility Reporting System.

Such care has been made available since 1966, (with certain limitations and co-payments), through the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) and now through the TRICARE health plan. In October 2001, TRICARE benefits were extended to retirees and their dependents aged 65 and over.[1] On Oct. 1, 2013, the Defense Health Agency replaced the TRICARE Management Activity.

The MHS has a $50+ billion budget and serves approximately 9.5 million beneficiaries.[4] The actual cost of having a government-run health care system for the military is higher because 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. The MHS employs more than 144,217 in 51 hospitals, 424 clinics, 248 dental clinics and 251 veterinary facilities across the nation and around the world, as well as in contingency and combat-theater operations worldwide.[5]

## History

[edit]

The Surgeon at Work at the Rear During an Engagement, 1862 Healthcare in the United States

Government health programs

* Federal Employees Health Benefits Program (FEHBP)
* Indian Health Service (IHS)
* Medicaid / State Health Insurance Assistance Program (SHIP)
* Medicare
* Prescription Assistance (SPAP)
* Military Health System (MHS) / Tricare
* Children's Health Insurance Program (CHIP)
* Program of All-Inclusive Care for the Elderly (PACE)
* Veterans Health Administration (VHA)

Private health coverage

* Consumer-driven healthcare
* Flexible spending account (FSA)
* Health reimbursement account (HRA)
* Health savings account (HSA)
* High-deductible health plan (HDHP)
* Medical savings account (MSA)
* Private Fee-For-Service (PFFS)
* Health insurance in the United States
* Health insurance marketplaces
* Premium tax credit
* Managed care (CCP)
* Exclusive provider organization (EPO)
* Health maintenance organization (HMO)
* Preferred provider organization (PPO)
* Medical underwriting

Health care reform law

* Emergency Medical Treatment and Active Labor Act (1986)
* Health Insurance Portability and Accountability Act (1996)
* Medicare Prescription Drug, Improvement, and Modernization Act (2003)
* Patient Safety and Quality Improvement Act (2005)
* Health Information Technology for Economic and Clinical Health Act (2009)
* Patient Protection and Affordable Care Act (2010)

State level reform

* Dirigo Health (Maine)
* Massachusetts health care reform
* Oregon Health Plan
* SustiNet (Connecticut)
* Vermont health care reform

Municipal health coverage

* Healthcare in California
* Healthy San Francisco
* Healthy Way LA
* My Health LA
* Fair Share Health Care Act (Maryland)
* Healthy Howard (Howard Co., Maryland)

* v
* t
* e

Before the Civil War, medical care in the military was provided largely by the regimental surgeon and surgeons' mates. While attempts were made to establish a centralized medical system, care provision was largely local and limited. Treatment for disease and injury was, by modern standards, primitive.[citation needed]

The Civil War saw improvements in medical science, communications and transportation that made centralized casualty collection and treatment more practical.[citation needed]

In World War I, the U.S. Army Medical Department expanded and developed its organization and structure. Care began on the battlefield and was then transferred to successively better levels of medical capability. Much of this capability was located in the combat theater so that soldiers could be easily returned to duty if possible.[citation needed]

Expansion continued during World War II, but without the benefit of an organizational plan.[citation needed]

After World War II, the Executive Branch of the U.S. Government was reorganized. The Department of War and Department of the Navy were merged into a single Department of Defense (DOD). This caused friction between the Army and Navy medical corps. Furthermore, the Air Force, originally part of the Army, was created as a separate military service with its own separate Medical Service.[citation needed]

Changes in the perception of health care after World War II and an assessment of medical services provided to dependents caused Congress to re-evaluate the dependent health care benefit in the late 1950s. 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).[6]

In the late 1980s, because of escalating costs, claims paperwork demands and general beneficiary dissatisfaction, DOD launched 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 better 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.[citation needed]

Although DOD's initial intent under CRI was to award three competitively bid contracts covering six states, it received only one bid, from Foundation Health Corporation (now Health Net) covering California and Hawaii. Foundation delivered services under this contract between August 1988 and January 1994.[citation needed]

In late 1993, driven by requirements in the DoD Appropriation Act for Fiscal Year 1994, DoD announced plans to implement by May 1997 a nationwide managed care program for the MHS. 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 each region. Under TRICARE, seven managed care support contracts were awarded covering DoD's 12 health care regions.[7]

TRICARE has been restructured several times, with contract regions having been redrawn , Base Realignment and Closure, and by adding "TRICARE For Life" benefits in 2001 for those who are Medicare-eligible.[8]

## Coverage gaps

[edit]

As of 2010, about 1.3 million of the 12.5 million nonelderly veterans in the United States did not have health insurance coverage or access to Veterans Affairs (VA) health care, according to a 2012 report by the Urban Institute and the Robert Wood Johnson Foundation that used 2010 data from the Census Bureau and the 2009 and 2010 National Health Interview Surveys (NHIS). The report also found that:

* When family members of veterans are included, the uninsured total rises to 2.3 million.
* An additional 900,000 veterans use VA health care but have no other coverage.
* Uninsured veterans are more likely to be male (90%), non-Hispanic white (70%), unmarried (58%) and earned a high school degree (41%).
* More than 40% are younger than 45.

The US Patient Protection and Affordable Care Act, enacted in 2010, has provisions intended to make it easier for uninsured veterans to obtain coverage. Under the act, veterans with incomes at or below 138% of the Federal Poverty Line ($30,429 for a family of four in 2010) would qualify for coverage as of January 2014; this group constitutes nearly 50% of veterans who are currently uninsured. Another 40.1% of veterans and 49% of their families have incomes that qualify for new subsidies through health insurance exchanges with the PPACA.[9][10]

Additionally, most Tricare plans are currently exempt from conforming to the new healthcare laws under the PPACA. Several bills have been proposed since the PPACA was enacted in 2010, including the most recent S. 358, "Access to Contraception for Women Servicemembers and Dependents Act of 2015"[11] sponsored by Senior Senator from New Hampshire Jeanne Shaheen. Under most current Tricare plans (with the exception of Prime), the health benefit is not considered "insurance" and does not cover women's contraceptives at 100% with no cost-sharing, deductibles, or co-payments.[12]

Female military servicemembers and female dependents of servicemembers continue to pay out of pocket for contraceptive services they receive at civilian doctor's offices under plans such as Tricare Standard, where the services are not rendered at a Military Treatment Facility by DoD doctors or contractors. However, The Military Health System, The Defense Health Agency, and Tricare[13] all advertise that they meet the "minimum essential coverage" standard for all military servicemembers. Additionally, the Defense Finance and Accounting Service reports for servicemembers to the Internal Revenue Service each year that every Tricare-eligible servicemember has a health benefit that meets the requirements of "minimum essential coverage",[14] even though Tricare coverage does not meet the standards of minimum essential coverage.

## Components

[edit]

Led by the Office of the Assistant Secretary of Defense for Health Affairs, the Military Health System includes several core organizational areas including:

* Defense Health Agency (DHA)
* Joint Staff Surgeon
* Uniformed Services University of the Health Sciences (USUHS)
* Military Treatment Facilities

The MHS also includes the medical departments of the Army, Navy, and Air Force, and TRICARE-authorized providers (including private sector healthcare providers, hospitals and pharmacies).[15]

## Facilities

[edit]

See Category:Medical installations of the U.S. Department of Defense.

This section needs expansion. You can help by adding to it. (January 2009)

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## See also

[edit]

* Assistant Secretary of Defense for Health Affairs
* Military medicine
* Defense Health Agency
* Surgeon General of the United States Army
* Surgeon General of the United States Navy
* Surgeon General of the United States Air Force
* TRICARE
* Uniformed Services University of the Health Sciences
* US Family Health Plan
* Defense Health Program Budget Activity Group

## References

[edit]

1. ^ a b Best, Richard A. Jr. (2005-05-05). "Military Medical Care Services: Questions and Answers" (PDF). Congressional Research Service. Retrieved 2008-05-23.
2. ^ "About the Military Health System". Military Health System. Retrieved 2019-11-25.
3. ^ "Eligibility | TRICARE". www.tricare.mil. Retrieved 2019-11-25.
4. ^ "Health.mil". Archived from the original on 2014-07-02. Retrieved 2014-12-03.
5. ^ "Annual Evaluation of the TRICARE Program". Military Health System. Retrieved 2019-11-25.
6. ^ Jones, M.D., Col. D. E. Casey (2001-04-10). "Unification of the Military Health System: A Half-Century Unresolved Debate" (PDF). Strategic Research Project, U.S. Army War College. Archived from the original (PDF) on 2009-02-27. Retrieved 2008-05-23.
7. ^ "Defense Health Care: Despite TRICARE Procurement Improvements, Problems Remain" (PDF). United States General Accounting Office. 1995-08-03. Retrieved 2008-05-26.
8. ^ "Tricare for Life". Air & Space Forces Magazine. Retrieved 2023-11-08.
9. ^ "Mortgage Uninsured Veterans and Family Members: Who Are They and Where Do They Live?". JournalistsResource.org, retrieved June 18, 2012
10. ^ Haley, Jennifer; Kenney, Genevieve M. (2012). "Uninsured Veterans and Family Members: Who Are They and Where Do They Live?" (PDF). Urban Institute. Archived from the original (PDF) on 2015-05-11. Retrieved 2012-06-18.
11. ^ "Access to Contraception for Women Servicemembers and Dependents Act of 2015 (S. 358)". GovTrack.us. Retrieved 2015-12-23.
12. ^ "Poll: Free Birth Control for all MilSpouses, Troops?". SpouseBuzz.com. Retrieved 2015-12-23.
13. ^ "About Us - TRICARE and the Affordable Care Act". www.tricare.mil. Retrieved 2015-12-23.
14. ^ "Affordable Care Act 2014 tax information". www.dfas.mil. Retrieved 2015-12-23.
15. ^ "Elements of the MHS". Military Health System. Retrieved 2019-11-25.

### Sources

[edit]

* This article incorporates public domain material from Task Force on the Future of Military Health Care: Final Report (PDF). United States Government.
* This article incorporates public domain material from Military Medical Care Services: Questions and Answers (PDF). United States Government.
* This article incorporates public domain material from Unification of the Military Health System: A Half-Century Unresolved Debate (PDF). United States Government. Archived from the original (PDF) on 2009-02-27.
* This article incorporates public domain material from Defense Health Care: Despite TRICARE Procurement Improvements, Problems Remain (PDF). United States Government.

## External links

[edit]

Wikimedia Commons has media related to Military Health System.

* Military Health System official website
* 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)
* Pat Flanders is the Chief Information Officer (CIO) and a Deputy Assistant Director for the Defense Health Agency (DHA) (MHS-OCIO)

* v
* t
* e

United States Department of Defense

* Headquarters: The Pentagon

* Lloyd Austin, Secretary of Defense
* Kathleen Hicks, Deputy Secretary of Defense

Office of the Secretary of Defense
(including defense agencies and DoD field activities)

| Deputy Secretary of Defense|

* Deputy's Advisory Working Group
* Office of Net Assessment
* Special Access Program Oversight Committee

|

Under Secretary of Defense
for Acquisition and Sustainment|

* Defense Contract Management Agency
* Defense Logistics Agency
* Defense Threat Reduction Agency
* Office of Economic Adjustment
* Defense Acquisition University
* Defense Acquisition Board
* Defense Microelectronics Activity

Under Secretary of Defense
for Research and Engineering|

* Defense Advanced Research Projects Agency
* Defense Innovation Unit
* Defense Technical Information Center
* Department of Defense Test Resource Management Center
* Missile Defense Agency

Under Secretary of Defense for Policy|

* Defense Security Cooperation Agency
* Defense POW/MIA Accounting Agency
* Defense Policy Board Advisory Committee

Under Secretary of Defense (Comptroller)|

* Defense Contract Audit Agency
* Defense Finance and Accounting Service

Under Secretary of Defense
for Personnel and Readiness|

* Defense Commissary Agency
* Department of Defense Education Activity
* Defense Human Resources Activity
* Defense Activity for Non-Traditional Education Support
* Defense Equal Opportunity Management Institute
* Defense Travel Management Office
* Defense Civilian Personnel Advisory Service
* Defense Health Agency
* Uniformed Services University of the Health Sciences

Under Secretary of Defense
for Intelligence|

* Defense Intelligence Agency
* Defense Counterintelligence and Security Agency
* Defense Information Systems Agency (White House Communications Agency)
* National Geospatial-Intelligence Agency
* National Reconnaissance Office
* National Security Agency/Central Security Service (Director/Chief)

Assistant to the Secretary of Defense for Public Affairs|

* Defense Media Activity (American Forces Press Service, American Forces Radio and Television Service, Stars and Stripes, The Pentagon Channel)

General Counsel of the Department of Defense|

* Defense Legal Services Agency (Office of Military Commissions)

Chief Management Officer of the Department of Defense|

* Pentagon Force Protection Agency
* Washington Headquarters Services (White House Military Office)

Military Departments

| Department of the Army|

* Secretary of the Army
The Secretariat: Under Secretary of the Army
* Assistant Secretary for Acquisition, Logistics, and Technology
* Assistant Secretary for Civil Works
* Assistant Secretary (Financial Management and Comptroller)
* Assistant Secretary of the Army for Installations, Energy and Environment
* Assistant Secretary of the Army for Manpower and Reserve Affairs
* General Counsel of the Army
* The Administrative Assistant
The Army Staff: Chief of Staff of the Army
* Vice Chief of Staff of the Army
* Sergeant Major of the Army
* Deputy Chief of Staff G-8
* Chief of Chaplains
* Judge Advocate General
* Provost Marshal General
* Surgeon General
U.S. Army field organizations: see Structure of the United States Army

|

Department of the Navy|

* Secretary of the Navy
The Secretariat: Under Secretary of the Navy
* Assistant Secretary of the Navy (Financial Management and Comptroller)
* Assistant Secretary of the Navy (Installations and Environment)
* Assistant Secretary of the Navy (Manpower and Reserve Affairs)
* Assistant Secretary of the Navy (Research, Development and Acquisitions)
* General Counsel of the Navy
* Judge Advocate General
* Naval Criminal Investigative Service
* Naval Inspector General
Headquarters Marine Corps: Commandant of the Marine Corps
* Assistant Commandant of the Marine Corps
* Sergeant Major of the Marine Corps
* Chaplain
U.S. Marine Corps field organizations: see Organization of the United States Marine Corps
Office of the Chief of Naval Operations: Chief of Naval Operations
* Vice Chief of Naval Operations
* Master Chief Petty Officer of the Navy
* Director of Naval Reactors
* Chief of Chaplains
* Chief of Naval Personnel
* Surgeon General
United States Navy field organizations: see Structure of the United States Navy

Department of the Air Force|

* Secretary of the Air Force
The Secretariat: Under Secretary of the Air Force
* Assistant Secretary of the Air Force (Acquisition)
* Assistant Secretary of the Air Force (Financial Management & Comptroller)
* Assistant Secretary of the Air Force (Installations, Environment & Logistics)
* Assistant Secretary of the Air Force (Manpower & Reserve Affairs)
* General Counsel of the Department of the Air Force
* Air Force Office of Special Investigations
The Air Staff: Chief of Staff of the Air Force
* Vice Chief of Staff of the Air Force
* Chief Master Sergeant of the Air Force
* Chief of Chaplains
* Chief of Safety
* Chief Scientist
* Judge Advocate General
* Surgeon General
U.S. Air Force field organizations: Major Commands
* Direct Reporting Units
* Field Operating Agencies
Space Staff: Chief of Space Operations
* United States Space Force field organizations

Joint Chiefs of Staff

* Chairman of the Joint Chiefs of Staff
Vice Chairman of the Joint Chiefs of Staff
* Senior Enlisted Advisor to the Chairman
* Joint Requirements Oversight Council
* Director of the Joint Staff
* Joint Staff
* National Military Command Center
* Alternate National Military Command Center
* National Defense University
* Joint Personnel Recovery Agency

Combatant Commands

* Africa Command
* Central Command
* European Command
* Northern Command
* Indo-Pacific Command
* Southern Command
* Space Command
* Cyber Command
* Special Operations Command
* Strategic Command
* Transportation Command

National Guard Bureau

* Chief of the National Guard Bureau
* Air National Guard
* Army National Guard

Office of the Inspector General

* Defense Criminal Investigative Service

* v
* t
* e

United States Armed Forces

Legend
A = Army
MC = Marine Corps
N = Navy
AF = Air Force
SF = Space Force
CG = Coast Guard

Leadership|

* President of the United States
* Secretary of Defense
* Deputy Secretary of Defense
* Secretary of Homeland Security
* Deputy Secretary of Homeland Security
* Joint Chiefs of Staff:
* Chairman
* Vice Chairman
* Committees on Armed Services
* Senate
* House
* Active duty four-star officers
* Active duty three-star officers
* United States military seniority
* National Security Act of 1947
* Goldwater–Nichols Act

Components|

| Military departments|

* Department of Defense
* Secretary
* Department of the Army
* Secretary
* Department of the Navy
* Secretary
* Department of the Air Force
* Secretary
* Department of Homeland Security
* Secretary

|

Service branches and heads|

* Chief of Staff of the United States Army
* Commandant of the Marine Corps
* Chief of Naval Operations
* Chief of Staff of the United States Air Force
* Chief of Space Operations
* Commandant of the Coast Guard

Reserve components|

* Reserves:
* A
* MC
* N
* AF
* CG
* National Guard:
* A
* AF

Civilian auxiliaries|

* Military Auxiliary Radio System
* Marine Corps Cyber Auxiliary
* Merchant Marine
* Civil Air Patrol
* Coast Guard Auxiliary

Unified combatant command|

* Africa
* Central
* European
* Indo-Pacific
* Northern
* Southern
* Space
* Cyber
* Special Operations
* Strategic
* Transportation

Structure|

* United States Code
* Title 10
* Title 14
* Title 32
* Title 50
* The Pentagon
* Installations
* Units:
* A
* MC
* N
* AF
* SF
* CG
* Logistics
* Media
* Unit mottoes

Operations
and history|

* Budget
* Current deployments
* Conflicts
* Wars
* Civil affairs

History|

* A
* MC
* N
* AF
* SF
* CG

Timeline|

* Colonial
* World War II

By ancestry|

* African Americans
* Asian Americans
* Buddhist Americans
* Jewish Americans
* Muslim Americans
* Sikh Americans
* Hispanic Americans
* Civil War
* Air Force
* Coast Guard
* Marine Corps
* Navy
* Academy

History centers|

* Army Center of Military History
* Marine Corps History Division
* Naval History and Heritage Command
* Air Force Historical Research Agency

War artists|

* Army Art Program
* Air Force Art Program

Personnel|

| Training|

* Service academies:
* A (prep)
* MC/N (prep)
* AF/SF (prep)
* CG
* Merchant Marine
* ROTC
* A
* MC/N
* AF/SF
* Officer candidate/training school:
* A
* MC
* N
* AF/SF
* Warrant officer:
* A
* MEPS
* ASVAB
* The Basic School (MC)
* Enlisted recruit training:
* A
* MC
* N
* AF/SF
* CG
* Other education

|

Uniforms|

* Uniforms:
* A
* MC
* N
* AF
* SF
* Awards & decorations:
* Inter-service
* A
* MC/N
* AF/SF
* CG
* Foreign
* International
* Devices
* Badges:
* Identification
* A
* MC
* N
* AF
* SF
* CG

Ranks|

* Officer:
* A
* MC
* N
* AF
* SF
* CG
* Warrant officers
* Enlisted:
* A
* MC
* N
* AF
* SF
* CG

Other|

* Oath:
* Enlistment
* Officer
* Creeds & Codes:
* Code of Conduct
* NCO
* A
* MC
* N
* AF
* CG
* Service numbers:
* A
* MC
* N
* AF
* CG
* Military Occupational Specialty/Rating/Air Force Specialty Code
* Pay
* Uniform Code of Military Justice
* Judge Advocate General's Corps
* Military Health System/Tricare
* Separation
* Veterans Affairs
* Conscription
* Chiefs of Chaplains:
* A
* MC
* N
* AF
* CG

Equipment|

* A (Designations)
* MC:
* vehicles
* weapons
* other
* N
* AF
* CG

| Land|

* Individual weapons
* Crew-served weapons
* Vehicles (active)

|

Sea|

* All watercraft
* Ships:
* A
* N
* active
* future
* AF
* CG
* MSC
* Weapons:
* N
* Reactors

Air|

* Aircraft
* World War I
* active
* future
* Aircraft designation
* Helicopter arms

Other|

* WWII equipment
* Nuclear football
* Electronics (designations)
* Flags:
* A
* MC
* N
* AF
* SF
* CG
* Ensign
* Jack
* Guidons
* Food
* WMDs:
* Nuclear
* Biological
* Chemical

* Category
* A
* MC
* N
* AF
* SF
* CG
* Navboxes
* A
* MC
* N
* AF
* SF
* CG

Authority control databases

International|

* ISNI
* VIAF

National|

* United States

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