Community and Family Policy, the Office of the Assistant Secretary of Defense for Reserve Affairs, and the Office of the Deputy Under Secretary of Defense for Military Personnel Policy.
The ASDHA oversees the Military Health System (MHS), which encompasses the coordinated efforts of the medical departments of the Army, Navy, Marine Corps, Air Force, Coast Guard, and Joint Chiefs of Staff; the Combatant Command surgeons; and private-sector health-care providers, hospitals, and pharmacies (DOD Directive 5136.01, June 4, 2008). The primary goal of the MHS is to provide emergency and long-term casualty care and to maintain the health readiness of military personnel by promoting physical and mental fitness and healthy behaviors. In addition, the MHS ensures the delivery of health care to all DOD service members, retirees, and their families. To support all those activities, the MHS devotes substantial resources to education of its medical personnel and to research and development to advance military medicine (DOD, 2009; Task Force on the Future of Military Health Care, 2007).
The MHS provides direct care to most active-duty service members through military treatment facilities (MTFs) and clinics. The direct care is supplemented by care purchased from the civilian sector. Retirees and dependent family members (see Box 5.1) of active-duty service members are also eligible to receive care at an MTF on a space-available basis; priority is given to those enrolled in TRICARE Prime.1 Worldwide, the MHS direct-care infrastructure includes 59 military hospitals, 413 medical clinics, and 413 dental clinics (TMA, 2009b), and employs over 44,000 civilians and 89,000 military personnel (Jansen, 2009). Responsibility for delivering health care to garrisoned and deployed troops remains with the health departments of the individual services—Army, Navy,2 and Air Force—which also retain considerable autonomy in the management of their own facilities and personnel. Of some 9.3 million eligible beneficiaries, by 2010, 43% will be active-duty personnel and their dependents, and 57% will be retirees and their dependents (Jansen, 2009). In 2007, 41% of all DOD eligible beneficiaries used direct care, 19% used care purchased through the TRICARE provider network, 25% used Medicare providers, and 14% used other civilian provider networks or VA services. Active-duty personnel and their dependents relied more heavily on direct care and purchased care; 58% used direct care, 32% used purchased care, and 9% used other civilian care (Andrews et al., 2008).
DOD health benefits are delivered through the TRICARE program, which is available to active-duty and reserve-component members, military retirees, and their dependent family members under one of several plans. To enroll in any TRICARE plan, service members, their families, and retirees must first establish eligibility through the Defense Enrollment Eligibility Reporting System (DEERS). Active-duty and retired service members, including National Guard and reserve members activated for at least 30 days, are automatically registered in DEERS, but individual service members are responsible for registering their family members, updating their status, and ensuring that their information is current and correct (TMA, 2009c). Active-duty service members, including members of the reserve components activated for at least 30 days, are required to enroll in TRICARE Prime. Eligible service members may also enroll their dependent family members in TRICARE Prime, but dependents may choose to pay extra to enroll in TRICARE Extra, a preferred provider option–like benefit, or seek coverage through a