apart in North Chicago since 1926. By the late 1990s, each was underused because of the shift of most patient care to outpatient settings. In addition, the naval hospital had become obsolete and needed to be replaced. When the NCVAMC’s inpatient operations were recommended for closure in 1999, local veterans organized to keep it open. The Illinois congressional delegation, aware that the Navy was planning to build a replacement hospital, urged the DoD and the VA to combine their services in a state-of-the-art federal health care center. Senator Richard Durbin later explained that

the aim of the delegation was to keep the North Chicago VA Medical Center open, improve options for medical care for the Navy, improve training options for VA and Navy medical personnel, reduce costs, and improve access to health care for veterans and Department of Defense beneficiaries. (Durbin, 2003)

In 2002, the assistant secretary of defense for health affairs and the VA under secretary for health—as co-chairs of the Health Executive Council (HEC)—agreed on a plan to share facilities and services in North Chicago. In a multistep process, the Navy would close its hospital and use the NCVAMC to provide emergency and inpatient care to its beneficiaries and build a shared ambulatory care center adjacent to the NCVAMC. The VA would renovate and upgrade the NCVAMC’s inpatient medical and surgical facilities and emergency department and allow Navy surgeons to practice in the VA hospital building. According to William Winkenwerder, Jr., the assistant secretary of defense for health affairs,

With this agreement, the Navy gains a modern ambulatory care center at a cost less than building a new hospital. VA beneficiaries gain increased access to surgical care closer to their homes and families. And the overall operating expenses of both departments should be reduced. (VA, 2002)

In 2003, the Navy closed its inpatient psychiatry ward and began sending patients to the NCVAMC for acute inpatient psychiatry care. In 2004, the Navy moved its blood processing center to vacant space in the NCVAMC, in return for providing a share of the blood products to the VA. The departments also agreed to move the rest of the NHGL’s inpatient and emergency care and Navy surgeons to the NCVAMC in 2006, after the VA had completed a $13 million renovation of the NCVAMC’s inpatient medical and surgical facilities and emergency room. In June 2006, Navy inpatients began to be treated at the NCVAMC, and the NHGL became the Naval Health Clinic Great Lakes (NHCGL).

In 2005, the assistant secretary of defense for health affairs and the VA under secretary for health agreed to develop a federal health care facility that would integrate clinical and administrative services under a single line



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