The Economics of Air Force Medical Service Readiness

http://www.rand.org/content/dam/rand/pubs/technical_reports/2010/RAND_TR859.pdf

The Economics of Air Force Medical Service Readiness


John C. Graser, Daniel Blum, Kevin Brancato,
James J. Burks, Edward W. Chan, Nancy Nicosia,
Michael J. Neumann, Hans V. Ritschard,
Benjamin F. Mundell

Prepared for the United States Air Force


The Air Force Medical Service (AFMS) has three major missions: keeping the Air Force active duty population healthy and deployable for their wartime mission; maintaining the readiness
of AFMS personnel to perform their wartime health-care mission; and providing health-care
services for Air Force and other Department of Defense (DoD) retirees, dependents, and other
categories of eligible beneficiaries. To accomplish these missions, AFMS has a full-time force
of about 40,000 military and civilian personnel who operate 74 military treatment facilities
(MTFs) throughout the world and provide health care to about 2.6 million eligible beneficiaries.
In addition, the Air National Guard and Air Force Reserve have about 20,000 medical
personnel.
Since 2001, as part of the global war on terror, AFMS and the medical departments of the
Army and Navy have been tasked with supporting combat operations in Afghanistan and Iraq.
Specialists providing critical care, specifically surgeons and operating room nurses and technicians,as well as mental health professionals, have been in high demand. In addition to the
problem of filling these in-theater requirements with highly trained specialists, deployments
present another problem to AFMS: how to provide for the home-station health care these specialists would normally accomplish if they were not deployed. Their absence means that some
beneficiaries must find alternative sources of medical care. In addition, current funding methodologies mean that the resulting decreases in workloads (number of medical procedures performed) at the home station can adversely affect the portions of the AFMS budget that depend on these workloads to generate that funding. A final complication in the AFMS operating
environment is the reduction in the number of inpatient facilities and overall inpatient workload,
which has decreased opportunities for training critical-care specialists for wartime duties.
Under a project entitled “Economics of Air Force Medical Service Readiness,” the project
sponsor, then–Deputy Surgeon of the Air Force, Maj Gen C. Bruce Green, asked RAND
Project AIR FORCE to assess the AFMS operation by
• evaluating how AFMS functions as a health plan, a health-care provider, and a payer for
services, as well as how it relates to other DoD organizations
• examining how resource decisions are made and how the Medical Expense and Performance
Reporting System and other systems and processes affect resource allocation
within the U.S. Military Health System
• analyzing the effects of resource decisions on system incentives and medical readiness
• examining alternative methodologies for solving problems that are discovered.
iv The Economics of Air Force Medical Service Readiness
The research was conducted within the Resource Management Program of RAND Project
AIR FORCE. Data collection and analysis were performed between January 2008 and
September 2008, and a final project update was provided to the sponsor in September 2008,
with frequent updates in between.
This report should be of interest to government personnel with a stake in military healthcare
operations and resourcing issues. Related documents include the following:
• Christine Eibner, Maintaining Military Medical Skills During Peacetime: Outlining and
Assessing a New Approach, Santa Monica, Calif.: RAND Corporation, MG-638-OSD,
2008.
• Edward G. Keating, Marygail K. Brauner, Lionel A. Galway, Judith D. Mele, James J.
Burks, and Brendan Saloner, Air Force Physician and Dentist Multiyear Special Pay: Current
Status and Potential Reforms, Santa Monica, Calif.: RAND Corporation, MG-866-AF,
2009.
• Edward G. Keating, Hugh G. Massey, Judith D. Mele, and Benjamin F. Mundell, An
Analysis of the Populations of the Air Force’s Medical and Professional Officer Corps, Santa
Monica, Calif.: RAND Corporation, TR-782-AF, 2010.
• Don Snyder, Edward W. Chan, James J. Burks, Mahyar A. Amouzegar, and Adam C.
Resnick, How Should Air Force Expeditionary Medical Capabilities Be Expressed? Santa
Monica, Calif.: RAND Corporation, MG-785-AF, 2009.