Restructuring military health care: the winds of change blow stronger.

The Military Health Services System is an enormously complex enterprise, consisting of more than 400,000 personnel in the active, reserve, and civilian workforce, operating 148 hospitals and over 800 medical and dental clinics worldwide, and serving nearly 9 million beneficiaries. Expenditures on military health care activities will exceed $15 billion in 1993. Yet many people in leadership positions in government--both inside and outside the Department of Defense--question whether the current organization of the Military Health Services System is appropriate to accomplish the Department's medical missions. Some insiders have observed that having three military medical services is having two too many--that a single "purple" medical service, or at least a single management structure such as a Defense Health Agency, would better meet military mission requirements as the Defense Department undergoes post-Cold War downsizing. One of the most pressing challenges facing military health care managers is how to best organize resources to provide timely access to quality care and achieve economies at a time when civilian health care is itself in turmoil. This article provides a long-awaited update on the spirited debate over the need to reorganize the Military Health Services System--and the prescriptions ordered so far to cure the system's perceived organizational ills.