The Economics of Air Force Medical Service Readiness

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
Copyright Date: 2010
Published by: RAND Corporation
Pages: 130
https://www.jstor.org/stable/10.7249/tr859af
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  • Book Info
    The Economics of Air Force Medical Service Readiness
    Book Description:

    The Air Force Medical Service (AFMS) currently runs three in-theater hospitals for severely injured or wounded personnel. Part of the practioners' preparation was treating DoD beneficiaries for a broad range of injuries and illnesses. Opportunities for this preparation are not as numerous "in house" as they once were, and AFMS does not always get proper credit for those gained elsewhere. Proper credit for that work is important for funding.

    eISBN: 978-0-8330-5187-5
    Subjects: Health Sciences, Management & Organizational Behavior

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-viii)
  4. Figures
    (pp. ix-x)
  5. Tables
    (pp. xi-xii)
  6. Summary
    (pp. xiii-xvi)
  7. Acknowledgments
    (pp. xvii-xviii)
  8. Abbreviations
    (pp. xix-xxii)
  9. Glossary
    (pp. xxiii-xxiv)
  10. CHAPTER ONE Introduction
    (pp. 1-6)

    The immense value of the U.S. Military Health System (MHS) and its modern battlefield techniques for providing initial life-sustaining medical intervention and treatment and rapid aeromedical evacuation (AE) for the critically wounded have been demonstrated during military operations in Iraq and Afghanistan. Survival rates for the seriously wounded are the highest in U.S. military history, as measured by the died-of-wounds rate. In addition, the services have experienced their lowest historical rates for disease and nonbattle injuries.

    To provide medical services, each military department runs its own health-care operations as part of the larger MHS, under the policy and fiscal guidance...

  11. CHAPTER TWO Overview of the Air Force Medical Service
    (pp. 7-16)

    This chapter describes AFMS’s mission and recent history, its relationships with OASD(HA), TMA, the other military services, and the Air Force MAJCOMs. It also discusses the differences among the services’ health-care approaches, organizations, and funding.

    The Air Force Surgeon General’s web page provides the following vision and mission for AFMS:

    AFMS Vision: Provide quality, world-class healthcare and health service support to eligible beneficiaries anywhere in the world at anytime.

    AFMS Mission: The AFMS provides seamless health service support to the USAF and combatant commanders. The AFMS assists in sustaining the performance, health and fitness of every Airman. It promotes and...

  12. CHAPTER THREE Air Force Medical Service Funding
    (pp. 17-32)

    As noted in Chapter One, adequate funding is one of the key ingredients AFMS needs to meet its readiness requirements. This chapter discusses the AFMS funding process, how funding is justified, and the earnings and efficiency measures that can affect funding. We analyze the financial performance of the AFMS MTFs in detail, comparing it with those of the Army and Navy, and examine it in the context of long-term prospects for MHS funding.

    AFMS’s total budget in FY 2007 was about $5.2 billion (including GWOT Supplemental funding) and consisted of five appropriations: O&M, procurement, R&D, MILPERS, and MILCON. Generally, Congress...

  13. CHAPTER FOUR Measuring Military Medical Service Costs and Workloads
    (pp. 33-44)

    In evaluating MTF performance, we considered both the level of output and the resources used to produce that output. The predominant focus of the direct-care system is to improve health outcomes for individual patients and the overall population, meet access-to-care commitments, and advance patient satisfaction with the direct-care system. However, economics require serious consideration when assessing the long-term viability of MHS and its components, including AFMS. Holding health outcomes and military readiness constant, a moreefficient MTF is one that produces more output with a given set of inputs.

    One primary output of an MTF is the patient care—what we...

  14. CHAPTER FIVE Why Has the Air Force Medical Service’s Workload Decreased?
    (pp. 45-56)

    A challenge for AFMS has been maintaining a stable workload base in its clinics and hospitals. As we will show in more detail later, Air Force workload decreased substantially from FY 2000 to FY 2007.¹ Indeed, in FY 2007, AFMS performed 37 percent fewer inpatient procedures and conducted 31 percent fewer outpatient visits than in FY 2000 and filled 11 percent fewer prescriptions than in FY 2002.² These workload reductions have resulted in decreased DHP funding for the Air Force, which negatively affects the available resources, financial health, and management flexibility of AFMS. In addition, decreased funding also affects nonfinancial...

  15. CHAPTER SIX Options Available for Recapturing and Expanding Workloads
    (pp. 57-68)

    If its decreasing workload trends continue unabated, AFMS may face an inpatient workload crisis in the coming years. Continued decreases would mean further reductions in PPS and MERHCF earnings, would jeopardize training and maintaining the currency of critical-care specialists, could complicate recruiting and retention of critical-care specialists (if they perceive that AFMS inpatient opportunities are limiting their competency and professional progression), and could make it more and more difficult to continue operating the remaining nine CONUS hospitals in a post-GWOT environment.² This chapter outlines four options available to AFMS to recapture and/or increase AFMS critical-care specialists’ inpatient workloads:

    expand opportunities...

  16. CHAPTER SEVEN Conclusions
    (pp. 69-72)

    The last two decades have been turbulent for AFMS, with significant reductions and other changes to its MTF structure; changes in wartime requirements from large, fixed, in-theater hospitals to a more streamlined EMEDS approach and, now, satisfying wartime taskings to operate three major hospitals in Afghanistan, Iraq, and Qatar; major reductions in inpatient, ambulatory, and prescription workloads; and the resulting implications for funding because of the implementation of OSD workload-oriented funding methodologies. So far, the effects of workload reductions on AFMS funding have been relatively minor, primarily because of ample wartime supplemental funding and savings found in other parts of...

  17. APPENDIX A Medical Workload by Service Military Treatment Facility
    (pp. 73-82)
  18. APPENDIX B Readiness Full-Time Equivalents by Service
    (pp. 83-84)
  19. APPENDIX C Prospective Payment System
    (pp. 85-88)
  20. APPENDIX D Medicare-Eligible Retiree Health Care Fund
    (pp. 89-90)
  21. APPENDIX E Consolidation of Wilford Hall Medical Center and Brooke Army Medical Center
    (pp. 91-98)
  22. APPENDIX F Efficiency-Wedge Reductions
    (pp. 99-100)
  23. APPENDIX G Support to Landstuhl Regional Medical Center
    (pp. 101-102)
  24. Bibliography
    (pp. 103-106)
  25. Back Matter
    (pp. 107-107)